The Risk of Cerebral Microbleeds in Ischemic Stroke Patients Using Antiplatelet Therapies

Abstract

In recent years, interest in cerebral microbleeds (CMBs) has increased based on advances in magnetic resonance imaging (MRI) technology. Both MRI T2-weighted gradient-echo (GRE) and susceptibility-weighted imaging may be sensitive techniques for the detection of past and more recent brain hemorrhage. CMBs appear as rounded foci <5 mm in size and hypointense on T2*-weighted MRI. Reduction in the gradient-echo MRI signal is caused by hemosiderin deposits. The prevalence of CMBs in healthy population ranges 3.7–7.7%, whereas in patients with intracerebral hemorrhage is thought to be around 60%. While the prevalence of cerebral microbleeds in patients with cerebral infarction is higher than that in healthy adults, at 23% in patients with first ischemic stroke and 44% in patients with recurrent ischemic stroke. There is accumulating evidence that microbleed location in the brain is reflective of their underlying origin. Microbleeds in deep or infratentorial locations are thought to be suggestive of hypertension whereas those occurring in strictly lobar brain sites are indicative of cerebral amyloid angiopathy.