Skip to main content Accessibility help
  • Print publication year: 2011
  • Online publication date: July 2011

Chapter 18 - Other clinical manifestations of cerebralmicrobleeds

from Section 3 - Microbleeds in relation to specific populations, diseases and neurological symptoms


This chapter provides an overview of the prevalence and associations, temporal evolution and prognostic significance of cerebral microbleeds (CMBs) in patients with cerebrovascular diseases. The spatial distribution of microbleeds, as markers of small vessel microhemorrhagic or microaneurysmal lesions, may be of particular interest in attempts to understand the causes of macroscopic intracerebral hemorrhage (ICH) in life. Cerebral amyloid angiopathy is an important cause of primary ICH, particularly of lobar location. Chronic hypertension has been repeatedly identified as a strong influence on the frequency and extent of CMBs, in patients with established stroke as well as in healthy subjects without stroke. Hypertension is an important risk factor for CMBs. As CMBs reflect the bleeding tendency of the brain through fragile microvascular walls, interest has increased in utilizing CMBs in risk stratification of hemorrhagic complications for patients with antithrombotic treatment.


1. KatoH, IzumiyamaM, IzumiyamaK, TakahashiA, ItoyamaY. Silent cerebral microbleeds on T2*-weighted MRI: correlation with stroke subtype, stroke recurrence, and leukoaraiosis. Stroke 2002;33:1536–40.
2. WongKS, ChanYL, LiuJY, GaoS, LamWW. Asymptomatic microbleeds as a risk factor for aspirin-associated intracerebral hemorrhages. Neurology 2003;60:511–13.
3. FazekasF, KleinertR, RoobGet al. Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. AJNR Am J Neuroradiol 1999;20:637–42.
4. SchragM, McAuleyG, PomakianJet al. Correlation of hypointensities in susceptibility-weighted images to tissue histology in dementia patients with cerebral amyloid angiopathy: a postmortem MRI study. Acta Neuropathol 2010;119:291–302.
5. TatsumiS, ShinoharaM, YamamotoT. Direct comparison of histology of microbleeds with postmortem MR images: a case report. Cerebrovasc Dis 2008;26:142–6.
6. TanakaA, UenoA, TakayamaY, TakabayashiK. Small haemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas. Stroke 1999;30:1637–42.
7. FisherCM. Lacunes: small, deep cerebral infarcts. Neurology 1965;15:774–84.
8. GreenbergSM, NandigamRN, DelgadoPet al. Microbleeds versus macrobleeds: evidence for distinct entities. Stroke 2009;40:2382–6.
9. JeonSB, KwonSU, ChoAHet al. Rapid appearance of new cerebral microbleeds after acute ischemic stroke. Neurology 2009;73:1638–44.
10. CianchettiFA, NishimuraN, SchafferCB. Cortical microhaemorrhages reduce stimulus-evoked calcium responses in nearby neurons. J Cerebr Blood Flow Metab 2009;29:S217.
11. BaumannCR, SchuknechtB, LoRGet al. Seizure outcome after resection of cavernous malformations is better when surrounding hemosiderin-stained brain also is removed. Epilepsia 2006;47:563–6.
12. BaeznerH, BlahakC, PoggesiAet al. Association of gait and balance disorders with age-related white matter changes: the LADIS study. Neurology 2008;70:935–42.
13. WatanabeA, KobashiT. Lateral gaze disturbance due to cerebral microbleed in the medial lemniscus in the mid-pontine region: a case report. Neuroradiology 2005;47:908–11.
14. SmithDB, HitchcockM, PhilpottPJ. Cerebral amyloid angiopathy presenting as transient ischemic attacks. Case report. J Neurosurg 1985;63:963–4.
15. OkazakiH, ReaganTJ, CampbellRJ. Clinicopathologic studies of primary cerebral amyloid angiopathy. Mayo Clin Proc 1979;54:22–31.
16. ChamouardJM, DuyckaertsC, RancurelG, PoissonM, BugeA. [Transient ischemic attack in amyloid angiopathy.]Rev Neurol (Paris) 1988;144:598–602.
17. YongWH, RobertME, SecorDL, KleikampTJ, VintersHV. Cerebral hemorrhage with biopsyproved amyloid angiopathy. Arch Neurol 1992;49:51–8.
18. CadavidD, MenaH, KoellerK, FrommeltRA. Cerebral beta amyloid angiopathy is a risk factor for cerebral ischemic infarction. A case control study in human brain biopsies. J Neuropathol Exp Neurol 2000;59:768–73.
19. OlichneyJM, HansenLA, HofstetterCRet al. Cerebral infarction in Alzheimer's disease is associated with severe amyloid angiopathy and hypertension. Arch Neurol 1995;52:702–8.
20. WattendorffAR, FrangioneB, LuyendijkW, BotsGT. Hereditary cerebral haemorrhage with amyloidosis, Dutch type (HCHWA-D): clinicopathological studies. J Neurol Neurosurg Psychiatry 1995;58:699–705.
21. KimberlyWT, GilsonA, RostNSet al. Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy. Neurology 2009;72:1230–5.
22. MenonRS, KidwellCS. Neuroimaging demonstration of evolving small vessel ischemic injury in cerebral amyloid angiopathy. Stroke 2009;40:e675–7.
23. GreenbergSM, VonsattelJP, StakesJW, GruberM, FinklesteinSP. The clinical spectrum of cerebral amyloid angiopathy: presentations without lobar hemorrhage. Neurology 1993;43:2073–9.
24. RochJA, NighoghossianN, HermierMet al. Transient neurologic symptoms related to cerebral amyloid angiopathy: usefulness of T2*-weighted imaging. Cerebrovasc Dis 2005;20:412–14.
25. IzenbergA, AvivRI, DemaerschalkBMet al. Crescendo transient aura attacks: a transient ischemic attack mimic caused by focal subarachnoid hemorrhage. Stroke 2009;40:3725–9.
26. KumarS, GoddeauRP, Jr., SelimMHet al. Atraumatic convexal subarachnoid hemorrhage: clinical presentation, imaging patterns, and etiologies. Neurology 2010;74:893–9.
27. GreenbergSM, O’DonnellHC, SchaeferPW, KraftE. MRI detection of new hemorrhages: potential marker of progression in cerebral amyloid angiopathy. Neurology 1999;53:1135–8.
28. GregoireSM, BrownMM, KallisCet al. MRI detection of new microbleeds in patients with ischemic stroke: five-year cohort follow-up study. Stroke 2010;41:184–6.
29. JeonSB, LeeJW, KimSJet al. New cerebral lesions on T2*-weighted gradient-echo imaging after cardiac valve surgery. Cerebrovasc Dis 2010;30:194–9.
30. GoosJD, HennemanWJ, SluimerJDet al. Incidence of cerebral microbleeds: a longitudinal study in a memory clinic population. Neurology 2010;74:1954–60.
31. GreenbergSM, EngJA, NingM, SmithEE, RosandJ. Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage. Stroke 2004;35:1415–20.
32. Lesnik ObersteinSA, van den BoomR, van BuchemMAet al. Cerebral microbleeds in CADASIL. Neurology 2001;57:1066–70.
33. ViswanathanA, GuichardJP, GschwendtnerAet al. Blood pressure and haemoglobin A1c are associated with microhaemorrhage in CADASIL: a two-centre cohort study. Brain 2006;129:2375–83.
34. HennemanWJ, SluimerJD, CordonnierCet al. MRI biomarkers of vascular damage and atrophy predicting mortality in a memory clinic population. Stroke 2009;40:492–8.