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Updated: May 25, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Cerebral microinfarcts: a systematic review of neuropathological studies
Manon Brundel1, Jeroen de Bresser, Jeroen J van Dillen
1Department of Neurology, Utrecht Stroke Centre and Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands. m.brundel-2@umcutrecht.nl
Abstract:
Vascular cognitive impairment is an umbrella term for cognitive dysfunction associated with and presumed to be caused by vascular brain damage. Autopsy studies have identified microinfarcts as an important neuropathological correlate of vascular cognitive impairment that escapes detection by conventional magnetic resonance imaging (MRI). As a frame of reference for future high-resolution MRI studies, we systematically reviewed the literature on neuropathological studies on cerebral microinfarcts in the context of vascular disease, vascular risk factors, cognitive decline and dementia. We identified 32 original patient studies involving 10,515 people. The overall picture is that microinfarcts are common, particularly in patients with vascular dementia (weighted average 62%), Alzheimer's disease (43%), and demented patients with both Alzheimer-type and cerebrovascular pathology (33%) compared with nondemented older individuals (24%). In many patients, multiple microinfarcts were detected. Microinfarcts are described as minute foci with neuronal loss, gliosis, pallor, or more cystic lesions. They are found in all brain regions, possibly more so in the cerebral cortex, particularly in watershed areas. Reported sizes vary from 50 μm to a few mm, which is within the detection limit of current high-resolution MRI. Detection of these lesions in vivo would have a high potential for future pathophysiological studies in vascular cognitive impairment.
Insights
Cerebral microinfarcts are common in dementia patients, often missed by standard MRI. Detecting these small brain lesions could advance understanding of vascular cognitive impairment.
Area of Science:
- Neuropathology
- Neuroimaging
- Vascular Neurology
Background:
- Vascular cognitive impairment results from vascular brain damage.
- Cerebral microinfarcts are key but often undetected neuropathological findings.
- High-resolution MRI may detect microinfarcts.
Purpose of the Study:
- Systematically review neuropathological studies on cerebral microinfarcts.
- Establish a reference for future high-resolution MRI research.
- Correlate microinfarcts with vascular disease, risk factors, and cognitive decline.
Main Methods:
- Systematic literature review of 32 neuropathological patient studies.
- Inclusion of 10,515 individuals.
- Analysis of microinfarct prevalence across dementia subtypes and controls.
Main Results:
- Microinfarcts are prevalent in vascular dementia (62%) and Alzheimer's disease (43%).
- Found in 33% of mixed dementia and 24% of non-demented individuals.
- Microinfarcts occur in all brain regions, especially cortex and watershed areas, and vary in size.
Conclusions:
- Microinfarcts are common neuropathological findings in various cognitive impairment conditions.
- Their size is within the detection range of current high-resolution MRI.
- In vivo detection holds potential for studying vascular cognitive impairment pathophysiology.
