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Cerebral microbleed distribution following cardiac surgery can mimic cerebral amyloid angiopathy

Michele De Sciscio1, Paul De Sciscio2, Wilson Vallat3

  • 1Neurology & Stroke, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

BMJ Neurology Open
|August 2, 2021
PubMed
Abstract

Insights

Cerebral microbleeds (CMBs) are common after cardiac surgery, particularly valve replacement. These microbleeds differ in location from those seen in cerebral amyloid angiopathy (CAA).

Area of Science:

  • Neurology
  • Cardiovascular Surgery
  • Neuroradiology

Background:

  • Anecdotal observations suggest a high frequency of lobar-restricted cerebral microbleeds (CMBs) in patients with prior cardiac surgery.
  • These microbleeds can mimic findings associated with cerebral amyloid angiopathy (CAA).

Purpose of the Study:

  • To objectively determine the frequency and distribution of microbleeds in patients with a history of cardiac surgery.
  • To compare microbleed characteristics between patients who underwent coronary artery bypass grafting (CABG), valve replacement, and those with probable CAA.

Main Methods:

  • Retrospective comparative cohort study involving patients from two transient ischaemic attack (TIA) clinics.
  • Cohorts included patients with prior CABG (n=41), prior valve replacement (n=41), and probable CAA (n=41) meeting Modified Boston Criteria.

Main Results:

  • Lobar-restricted microbleeds were found in 65% of cardiac surgery patients; 39% met CAA diagnostic criteria.
  • Valve replacement patients showed higher microbleed prevalence (90%) and lobar-restricted microbleed counts compared to CABG patients.
  • Subcortical white matter (SWM) microbleeds were proportionally more frequent in cardiac surgery patients than in CAA patients, aiding differentiation.

Conclusions:

  • Lobar-restricted microbleeds are prevalent in patients with a history of cardiac surgery.
  • The distribution of microbleeds, particularly the proportion involving subcortical white matter, differs between post-cardiac surgery patients and those with CAA.
Keywords:
amyloidcardiologystroke

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