Related Experiment Video
Updated: Mar 16, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Cerebral Microbleeds and Cortical Superficial Siderosis in Patients Presenting With Minor Cerebrovascular Events
Charlotte Zerna1, Jayesh Modi1, Lisa Bilston1
1From the Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada (C.Z., L.B., S.B.C., E.E.S.); Medanta - The Medicity Hospital, Gurgaon, India (J.M.); and Division of Neurology, Department of Medicine, McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.).
Background And Purpose:
Transient focal neurological episodes occur in cerebral amyloid angiopathy (CAA) and can mimic transient ischemic attack (TIA). Risk factors and outcomes of minor ischemic stroke or TIA might differ in patients with and without cerebral microbleeds (CMBs), including CAA-consistent lobar CMB.
Methods:
Baseline magnetic resonance imaging (MRI) was analyzed for CMBs and cortical superficial siderosis in 416 patients in the prospective computed tomography and MRI in the CATCH study (Triage of TIA and Minor Cerebrovascular Events to Identify High Risk Patients). Clinical symptoms, baseline characteristics, recurrence, and 90-day modified Rankin Scale were prospectively collected. MRI white-matter hyperintensity was measured using the Fazekas scale.
Results:
CMBs were detected in 65 (15.6%) and cortical superficial siderosis in 11 patients (2.6%). Lobar CMBs were present in 49 (11.8%). In multivariable logistic regression adjusted for risk factors and age, subcortical Fazekas score was associated with lobar CMB (odds ratio, 2.07; 95% confidence interval, 1.23-3.48; P=0.006). Forty-two patients (10.1%) had lobar-only CMBs with or without cortical superficial siderosis consistent with modified Boston criteria for possible/probable CAA. The possible/probable CAA pattern was not predictive of recurrent TIA (odds ratio, 0.42; 95% confidence interval, 0.05-3.31; P=0.41), stroke (odds ratio, 1.24; 95% confidence interval, 0.26-5.99; P=0.79), or 90-day modified Rankin Scale score ≥2 (odds ratio, 1.38; 95% confidence interval, 0.62-3.07; P=0.42).
Conclusions:
CMBs in TIA and minor stroke are moderately common but do not predict recurrence or 90-day outcome. CAA-related transient focal neurological episodes and TIA have overlapping clinical symptoms, suggesting that MRI may be needed for differentiation.
Insights
Cerebral amyloid angiopathy (CAA) can cause transient neurological episodes mimicking TIA. Microbleeds (CMBs) are common in TIA/stroke but don't predict outcomes, suggesting MRI is vital for differentiating CAA.
Area of Science:
- Neurology
- Neuroradiology
- Cerebrovascular Disease
Background:
- Transient focal neurological episodes in cerebral amyloid angiopathy (CAA) can mimic transient ischemic attacks (TIAs).
- Cerebral microbleeds (CMBs) are associated with CAA and may influence TIA/stroke risk and outcomes.
Purpose of the Study:
- To investigate the prevalence of CMBs and cortical superficial siderosis in patients with TIA or minor stroke.
- To determine if CMBs, particularly lobar CMBs consistent with CAA, predict recurrence or 90-day functional outcomes.
Main Methods:
- Analysis of baseline MRI scans for CMBs and cortical superficial siderosis in 416 CATCH study participants.
- Prospective collection of clinical data, including symptoms, risk factors, recurrence, and 90-day modified Rankin Scale scores.
- Measurement of white-matter hyperintensity using the Fazekas scale.
Main Results:
- CMBs were detected in 15.6% and cortical superficial siderosis in 2.6% of patients.
- Lobar CMBs were present in 11.8%, and a pattern consistent with possible/probable CAA was found in 10.1%.
- Subcortical white-matter hyperintensity correlated with lobar CMBs (OR 2.07, P=0.006); however, CAA patterns did not predict TIA recurrence, stroke, or poor 90-day outcome.
Conclusions:
- CMBs are moderately common in TIA and minor stroke but do not predict recurrence or functional outcomes.
- CAA-related transient neurological episodes and TIAs share overlapping symptoms, highlighting the need for MRI in differential diagnosis.
