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Published on: April 23, 2021
Clinical associations of cerebral microbleeds on magnetic resonance neuroimaging
Matthew Schrag1, David M Greer1
1Department of Neurology, Yale University and Yale-New Haven Hospital, New Haven, Connecticut.
Abstract:
Susceptibility-weighted and gradient-recalled echo T2* magnetic resonance imaging have enabled the detection of very small foci of blood within the brain, which have been termed "cerebral microbleeds." These petechial intraparenchymal hemorrhages have begun to emerge as diagnostically and prognostically useful markers in a variety of disease states. Severe hypertension and cerebral amyloid angiopathy are perhaps the best established microhemorrhagic conditions from neuroimaging literature; however, many others are also recognized including cerebral autosomal dominant arteriopathy, subcortical infarcts, and leukoencephalopathy (CADASIL), moyamoya disease, fat embolism, cerebral malaria, and infective endocarditis. Microbleeds are also a common finding in the setting of trauma and stroke. The purpose of this review is to broadly describe the neuroimaging of cerebral microbleeds in a wide variety of conditions, including the differences in their appearance and distribution in different disease states. In a few situations, the presence of microbleeds may influence clinical management, and we discuss these situations in detail. The major importance of this emerging field in neuroimaging is the potential to identify microvascular pathology at an asymptomatic or minimally symptomatic stage and create a window of therapeutic opportunity.
Insights
Cerebral microbleeds, small brain hemorrhages detected by MRI, are valuable diagnostic and prognostic markers. Recognizing their varied appearances across conditions offers potential for early therapeutic intervention.
Area of Science:
- Neuroimaging
- Neurology
- Vascular Medicine
Background:
- Susceptibility-weighted and gradient-recalled echo T2* MRI detect cerebral microbleeds (CMBs).
- CMBs are petechial intraparenchymal hemorrhages with emerging diagnostic and prognostic utility.
- Conditions associated with CMBs include severe hypertension, cerebral amyloid angiopathy, CADASIL, moyamoya disease, fat embolism, cerebral malaria, infective endocarditis, trauma, and stroke.
Purpose of the Study:
- To review the neuroimaging of cerebral microbleeds across diverse conditions.
- To describe variations in CMB appearance and distribution.
- To discuss the clinical management implications of CMB detection.
Main Methods:
- Review of neuroimaging literature on cerebral microbleeds.
- Analysis of CMB characteristics (appearance, distribution) in various pathologies.
- Discussion of clinical management strategies influenced by CMB findings.
Main Results:
- Cerebral microbleeds are detected using specific MRI sequences (SWI, T2* GRE).
- Distinct patterns of CMBs are observed in different neurological diseases.
- CMB detection can guide clinical management in certain scenarios.
Conclusions:
- Cerebral microbleeds are significant neuroimaging markers across a spectrum of diseases.
- Understanding CMB neuroimaging aids in identifying microvascular pathology.
- Early detection of CMBs may present therapeutic opportunities for asymptomatic or minimally symptomatic microvascular disease.
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