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Incidence, Locations, and Longitudinal Course of Cerebral Microbleeds in European Moyamoya
Holger Wenz1, Ralf Wenz2, Máté Maros2
1From the University Medical Center Mannheim, Department of Neuroradiology (H.W., R.W., M.M., M.A.-Z., C.G., A.F.) and Department of Neurosurgery (G.E.), University of Heidelberg, Mannheim, Germany. holger.wenz@umm.de.
Background And Purpose:
Cerebral microbleeds (cMBs) have previously been linked with especially high incidence in Asian patients with moyamoya together with high tendency to bleed. This, presumably, is characteristic of patients with moyamoya. Herein, we, therefore, investigate retrospectively the frequency, location, and longitudinal course of cMBs in a large German cohort.
Methods:
We included all patients with moyamoya who underwent standard magnetic resonance imaging, including T2*-weighted images, in our department between 1998 and 2015. Two independent readers evaluated magnetic resonance imaging scans to determine the occurrence of cMBs according to the Brain Observer Microbleed Scale. Demographics, initial symptoms leading to hospitalization, and associated diseases were obtained by chart review.
Results:
Overall, there was a total of 242 T2* studies of 101 included moyamoya patients available with a strong female predominance (69.3%). Eight patients (7.9%) were ≤18 years of age. We detected 25 cMBs within 13 patients (12.9%). One patient <18 of age was presented with a cMB; 2 of 3 patients with an intracranial hemorrhage as initial event demonstrated cMB(s). In 72 of 101 cases, there were 1719 person months of follow-up, with 3 adult patients showing 3 de novo cMBs in the course. The majority of cMBs (64.0%) were located at the cortex/gray-white junction.
Conclusions:
Although the frequency of cMBs herein is much higher than the expected age-specific incidence, it is still much lower compared with previous reports on cMBs in moyamoya patients of Asian descent. These results might reflect another ethnic-specific difference in patients diagnosed with moyamoya.
Insights
Cerebral microbleeds (cMBs) are less common in German moyamoya patients than in Asian populations, suggesting ethnic differences. Longitudinal analysis revealed new cMBs in some adults.
Area of Science:
- Neurology
- Radiology
- Neuroscience
Background:
- Cerebral microbleeds (cMBs) are frequently observed in Asian moyamoya patients.
- Moyamoya disease is characterized by a high tendency for bleeding.
Purpose of the Study:
- To investigate the frequency, location, and longitudinal course of cMBs in a German moyamoya cohort.
- To compare cMB incidence in German patients with previously reported Asian cohorts.
Main Methods:
- Retrospective analysis of 242 T2*-weighted MRI scans from 101 moyamoya patients (1998-2015).
- Evaluation of cMBs using the Brain Observer Microbleed Scale by two independent readers.
- Chart review for demographics, initial symptoms, and comorbidities.
Main Results:
- Cerebral microbleeds (cMBs) were detected in 12.9% of German moyamoya patients.
- The majority of cMBs were located at the cortex/gray-white junction.
- Three de novo cMBs were observed during follow-up in adult patients.
Conclusions:
- The frequency of cMBs in this German cohort is lower than in Asian moyamoya patients, suggesting potential ethnic-specific differences.
- While higher than expected for the general population, cMB incidence in this cohort is notably lower compared to Asian cohorts.
