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Published on: January 18, 2018
Cerebral Microbleeds in the Patients With Acute Stroke Symptoms
Sung Hyuk Heo1, Dongwhane Lee1, Yong Chul Kwon1
1Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea.
Abstract:
Background: Some patients with acute stroke symptoms do not show hyperintensities on diffusion-weighted image (DWI). A few case reports have indicated that acutely developed cerebral microbleeds (CMBs) might cause focal symptoms. This study sought to investigate the incidence and characteristics of symptomatic CMBs in the patients with acute stroke symptoms but without DWI ischemic lesions. Methods: We enrolled the patients with acute stroke symptoms who underwent magnetic resonance imaging including DWI and gradient echo (GRE) sequences within 7 days after symptom onset, at our prospective stroke registry. We then identified patients without DWI-positive ischemic lesions but with CMBs in the relevant brain regions. Results: Between January 2005 and February 2012, we identified 235 DWI-negative transient ischemic attack (n = 221) and stroke (n = 14) patients from 2129 consecutive patients at our registry. In total, 16 patients had CMBs corresponding to the focal symptoms. Among these 16 patients, 12 patients showed a hyperintense rim on DWI around a microbleed suspected to be related to focal symptoms; of the 12 patients, 7 experienced stroke symptoms for more than 24 h. However, the symptoms in the remaining patients (5 patients with the hyperintense rim and 4 patients without the hyperintense rim) improved within 24 h. Conclusion: Symptomatic microbleeds are infrequent but not rare in the patients with acute stroke symptoms. Perihematomal edema around an acute CMB can cause a hyperintense rim on DWI. Our results suggest that a combination of DWI and GRE imaging can help diagnose acute symptomatic CMBs.
Insights
Symptomatic cerebral microbleeds (CMBs) can cause acute stroke symptoms without diffusion-weighted image (DWI) lesions. Combining DWI and gradient echo (GRE) imaging aids in diagnosing these rare but significant microbleeds.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Acute stroke patients may lack diffusion-weighted imaging (DWI) hyperintensities.
- Case reports suggest acute cerebral microbleeds (CMBs) can manifest as focal neurological deficits.
- The incidence and characteristics of symptomatic CMBs in DWI-negative acute stroke patients require investigation.
Purpose of the Study:
- To determine the incidence of symptomatic CMBs in patients presenting with acute stroke symptoms but no DWI-positive ischemic lesions.
- To characterize the imaging findings and clinical course of these symptomatic CMBs.
Main Methods:
- Prospective enrollment of acute stroke patients within 7 days of symptom onset.
- Magnetic resonance imaging (MRI) including DWI and gradient echo (GRE) sequences.
- Identification of patients with DWI-negative lesions but relevant CMBs.
Main Results:
- 16 out of 235 DWI-negative transient ischemic attack/stroke patients had symptomatic CMBs.
- 12 patients showed a DWI hyperintense rim around the CMB; 7 of these had symptoms >24 hours.
- 5 patients with a DWI rim and 4 without had symptoms resolving within 24 hours.
Conclusions:
- Symptomatic microbleeds are an infrequent but notable cause of acute stroke symptoms in DWI-negative patients.
- Perihematomal edema around acute CMBs can create a DWI hyperintense rim.
- Combined DWI and GRE MRI is valuable for diagnosing acute symptomatic CMBs.
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