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Cerebral microbleeds (CMBs) are an increasingly common radiological finding in stroke, neurological and general medical practice. There are two published CMB rating scales that have been validated in hospital cohorts of stroke patients. The rating scales are the microbleed anatomical rating scale (MARS) and the brain observer micro bleed scale (BOMBS). This chapter considers the radiological criteria for defining CMBs and then discusses these standardized rating scales. The potential for automatically detecting and mapping CMBs in future is discussed briefly in the chapter. Mapping CMBs gives information on the burden of CMBs in different anatomical regions in the brain. Quantifying the number of CMBs may be relevant in exploring their relationship with other quantitative imaging or clinical data and for prognostic purposes. Although visual rating scales can improve the reliability of identifying and mapping CMBs, more sophisticated automated methods are under investigation.
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.
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