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Published on: April 23, 2021
Strictly Lobar Microbleeds Reflect Amyloid Angiopathy Regardless of Cerebral and Cerebellar Compartments
Young Hee Jung1, Hyemin Jang2,3, Seong Beom Park2,3
1Department of Neurology, Myongji Hospital, Hanyang University, Goyang, Korea (Y.H.J).
Background And Purpose:
We aimed to determine whether lobar cerebellar microbleeds or concomitant lobar cerebellar and deep microbleeds, in the presence of lobar cerebral microbleeds, attribute to underlying advanced cerebral amyloid angiopathy pathology or hypertensive arteriopathy.
Methods:
We categorized 71 patients with suspected cerebral amyloid angiopathy markers (regardless of the presence of deep and cerebellar microbleeds) into 4 groups according to microbleed distribution: L (strictly lobar cerebral, n=33), L/LCbll (strictly lobar cerebral and strictly lobar cerebellar microbleeds, n=13), L/Cbll/D (lobar, cerebellar, and deep microbleeds, n=17), and L/D (lobar and deep, n=8). We additionally categorized patients with cerebellar microbleeds into 2 groups according to dentate nucleus involvement: strictly lobar cerebellar (n=16) and dentate (n=14). We then compared clinical characteristics, Aβ (amyloid-β) positivity on PET (positron emission tomography), magnetic resonance imaging cerebral amyloid angiopathy markers, and cerebral small vessel disease burden among groups.
Results:
The frequency of Aβ positivity was higher in the L and L/LCbll groups (81.8% and 84.6%) than in the L/Cbll/D and L/D groups (37.5% and 29.4%; P<0.001), while lacune numbers were lower in the L and L/LCbll groups (1.7±3.3 and 1.7±2.6) than in the L/Cbll/D and L/D groups (8.0±10.3 and 13.4±17.7, P=0.001). The L/LCbll group had more lobar cerebral microbleeds than the L group (93.2±121.8 versus 38.0±40.8, P=0.047). The lobar cerebellar group had a higher Aβ positivity (75% versus 28.6%, P=0.011) and lower lacune number (2.3±3.7 versus 8.6±1.2, P=0.041) than the dentate group.
Conclusions:
Strictly lobar cerebral and cerebellar microbleeds are related to cerebral amyloid angiopathy, whereas any combination of concurrent lobar and deep microbleeds suggest hypertensive angiopathy regardless of cerebral or cerebellar compartments.
Insights
Strictly lobar cerebral and cerebellar microbleeds indicate cerebral amyloid angiopathy. Combinations of lobar and deep microbleeds suggest hypertensive arteriopathy, regardless of location. This research differentiates microbleed origins.
Area of Science:
- Neurology
- Neuroradiology
- Cerebrovascular Diseases
Background:
- Cerebral amyloid angiopathy (CAA) and hypertensive arteriopathy are common causes of microbleeds.
- Distinguishing between CAA and hypertensive arteriopathy is crucial for understanding disease progression and treatment.
- Lobar cerebellar microbleeds, alone or with deep microbleeds, require further investigation to determine their underlying pathology.
Purpose of the Study:
- To investigate whether lobar cerebellar microbleeds, with or without deep microbleeds, are associated with cerebral amyloid angiopathy (CAA) or hypertensive arteriopathy.
- To differentiate the underlying pathologies of various microbleed distributions in the brain.
Main Methods:
- Categorized 71 patients with suspected CAA markers into four groups based on microbleed distribution: strictly lobar cerebral (L), lobar cerebral and lobar cerebellar (L/LCbll), lobar cerebral, cerebellar, and deep (L/Cbll/D), and lobar cerebral and deep (L/D).
- Further categorized patients with cerebellar microbleeds into strictly lobar cerebellar and dentate nucleus groups.
- Compared clinical characteristics, amyloid-beta (Aβ) positron emission tomography (PET) positivity, MRI CAA markers, and cerebral small vessel disease burden across groups.
Main Results:
- Aβ positivity was significantly higher in the L and L/LCbll groups (81.8%, 84.6%) compared to L/Cbll/D and L/D groups (37.5%, 29.4%).
- Lacune numbers were lower in the L and L/LCbll groups (1.7±3.3, 1.7±2.6) than in the L/Cbll/D and L/D groups (8.0±10.3, 13.4±17.7).
- The strictly lobar cerebellar group showed higher Aβ positivity (75%) and lower lacune counts (2.3±3.7) than the dentate nucleus group (28.6%, 8.6±1.2).
Conclusions:
- Strictly lobar cerebral and cerebellar microbleeds are associated with cerebral amyloid angiopathy.
- Concurrent lobar and deep microbleeds indicate hypertensive arteriopathy, irrespective of the specific brain compartments involved.
