Associations and implications of cerebral microbleeds

Area of Science:

• Neurology
• Radiology
• Vascular Medicine

Background:

• Cerebral microbleeds (CMB) are small haemosiderin deposits visualized by MRI.
• CMB prevalence increases with age and is linked to cerebral vasculopathies like arteriolosclerosis and amyloid angiopathy.
• CMB often co-occur with other small vessel disease markers, including microinfarction and white matter hyperintensity.

Purpose of the Study:

• To review the associations of cerebral microbleeds.
• To discuss the clinical implications of CMB detection.
• To highlight uncertainties in managing patients with CMB.

Main Methods:

• Literature review of studies on cerebral microbleeds.
• Analysis of CMB association with age, vasculopathies, and radiological findings.
• Evaluation of CMB as a predictor of stroke recurrence and association with neurological impairments.

Main Results:

• CMB prevalence reliably increases with age and is associated with vasculopathies.
• Lobar CMB suggest amyloid angiopathy; CMB indicate vasculopathy severity and recurrence risk.
• CMB are linked to cognitive impairment, depression, and gait instability, but causality is debated.

Conclusions:

• The clinical significance of detecting cerebral microbleeds remains uncertain.
• Thrombolysis for ischemic stroke is not contraindicated in patients with CMB.
• Further studies are needed to determine optimal antithrombotic strategies for patients with CMB and vascular disease or atrial fibrillation.