Google Scholar. Kikuta K, Takagi Y, Nozaki K, Okada T, Hashimoto N: Histological analysis of microbleed after surgical resection in a patient with moyamoya disease. Superficial siderosis (SS) is a rare condition in which hemosiderin is deposited on the pial surface of the brain and/or spinal cord. Stroke. Inform patients that most people with swelling in areas of the brain do not experience symptoms, however, some people may experience symptoms such as headache, confusion, 2006 Jan 24;66(2):165-71. doi: 10.1212/01.wnl.0000194266.55694.1e. Vestibulocochlear nerve (CN VIII) dysfunction resulting in a sensorineural hearing loss is believed to be due to the combination of a long cisternal course (thus with ample exposure to the subarachnoid space) and the susceptibility of microglial cells (which have a role in myelination) to be damaged by iron compounds 4. Enter search terms to find related medical topics, multimedia and more. Interestingly, MBs are also a common finding in other populations, even in healthy elderly individuals. Conclusions: Before Over time, further sequences have been developed, including three-dimensional T2*-GRE [3] and the most sensitive one to date - susceptibility-weighted imaging (SWI) [4]. In a study of individuals with lobar ICH, a higher number of lobar hemorrhages at baseline (including MBs) predicted an increased risk of not only lobar ICH recurrence but also cognitive decline, functional dependence, or death in those individuals not dependent or demented by the time of admission [38]. Hemosiderin deposition in the brain as the footprint of high-altitude cerebral edema. Hemosiderosis caused by bleeding and red blood cell breakdown does not usually require treatment. Stroke. Cerebrovasc Dis. Gurol ME, Dierksen G, Betensky R, Gidicsin C, Halpin A, Becker A, Carmasin J, Ayres A, Schwab K, Viswanathan A, Salat D, Rosand J, Johnson KA, Greenberg SM: Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy. 31,39 Age-related changes in signal intensity from the pallidum or thalamus, possibly attributable to the deposition of iron, have been reported. Naka H, Nomura E, Wakabayashi S, Kajikawa H, Kohriyama T, Mimori Y, Nakamura S, Matsumoto M: Frequency of asymptomatic microbleeds on T2*-weighted MR images of patients with recurrent stroke: association with combination of stroke subtypes and leukoaraiosis. People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms read more and the metabolic syndrome Metabolic Syndrome Metabolic syndrome is characterized by a large waist circumference (due to excess abdominal fat), high blood pressure, resistance to the effects of insulin (insulin resistance) or diabetes, read more , can cause hemosiderosis. Tsushima Y, Aoki J, Endo K: Brain microhemorrhages detected on T2*-weighted gradient-echo MR images. The site is secure. 34 Hemosiderin deposition (which included hemorrhagic lacunes and microhemorrhages) was more predominant among ischemic stroke Neurology, 81 (20 . 2022 Oct 19;65(4):270-277. doi: 10.33160/yam.2022.11.001. Hemochromatosis more often requires treatment. Stroke. Epub 2016 Sep 19. Clinical presentation. MBs were first reported in association with intracerebral hemorrhage (ICH) [11]. 2006, 22: 8-14. Stroke. Two studies investigated the value of MBs in predicting progression from mild cognitive impairment to dementia. AV is the principal investigator in the following grants related to CAA: title: Project II, sponsor: NIH-NIA, sponsor number: 5P50AG005134; title: Effect of WMD on Gait and Balance in CAA, sponsor: NIH-NIA, sponsor number: 5K23AG028726. Epub 2017 Jun 5. I: Nair A, Sabbagh M, red. Michael, M.D. 2010;41:S103106. Part of 2002, 297: 353-356. If there is bleeding within an organ, such as in the lungs of people who have certain types of lung disease, iron from the blood cells often remains in that organ. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The lungs and kidneys are often sites of hemosiderosis. Stroke. Disclaimer. PLoS One. In contrast, strictly deep MBs were associated with vascular risk factors, lacunar infarcts, and WMH, but not with the APOE-4 allele. Although deep MBs may be identified in some AD cases, the vast majority of them (92%) show a lobar predominance. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Hsu W, Loevner L, Forman M, Thaler E. Superficial Siderosis of the CNS Associated with Multiple Cavernous Malformations. This deposition of this "foreign" material can occur all along the CNS, including the brain and the spine. Also, the topographic distribution of these MBs has been shown to be potentially associated with specific underlying vasculopathies. statement and If people have a disorder that causes excessive breakdown of red blood cells within the blood vessels (for example, hemolytic anemia Aplastic Anemia Aplastic anemia is a disorder in which the cells of the bone marrow that develop into mature blood cells are damaged, leading to low numbers of red blood cells, white blood cells, and/or platelets read more ), iron released from the red blood cells can accumulate within the kidneys (renal hemosiderosis). Brain. Clinically, these episodes may resemble transient ischemic attack (TIA) or seizures, depending on the negative or positive character of the symptoms. The patient's next of kin have consented to the publication of this article. We do not control or have responsibility for the content of any third-party site. The literature is divided as to whether the term superficial siderosis should be confined to cases where there is no history of symptomatic subarachnoid hemorrhage, or whether it is a blanket term referring to the superficial deposition of hemosiderin, irrespective of cause. 2010;113 (1): 97-101. 10.1161/STROKEAHA.110.607184. Use to remove results with certain terms Careers. Based on these guidelines, MBs can be described as small areas of signal void with associated blooming, excluding non-hemorrhagic causes of signal void. The amyloid cascade hypothesis [53], in combination with further theories on amyloid clearance through perivascular spaces [54], supports this notion. Martinez-Ramirez, S., Greenberg, S.M. AJNR Am J Neuroradiol. Arvanitakis Z, Leurgans SE, Wang Z, Wilson RS, Bennett DA, Schneider JA: Cerebral amyloid angiopathy pathology and cognitive domains in older persons. o [ pediatric abdominal pain ] In "localized"-type SS, hypointense MRI signals are localized in the cerebral cortex. HV, a consequence of long-standing hypertension over the microvasculature of the brain, is pathologically defined by the presence of lipofibrohyalinosis, which affects mostly the deep penetrating arterioles. eCollection 2022 Nov. Jordan N, Gvalda M, Cody R, Galante O, Haywood C, Yates P. Front Med (Lausanne). 2017 Apr 1;140(4):1107-1116. doi: 10.1093/brain/awx003. Please enable it to take advantage of the complete set of features! In general, the available literature provides support that MBs are independent contributors to cognitive impairment and that their topographic distribution may have specific associations with certain cognitive domains. Bayer AJ, Bullock R, Jones RW, Wilkinson D, Paterson KR, Jenkins L, Millais SB, Donoghue S: Evaluation of the safety and immunogenicity of synthetic Abeta42 (AN1792) in patients with AD. There are several ways to explain this dissociation between the post-mortem pathological findings of CAA and MB detection during life. 10.2176/nmc.47.564. Cerebral amyloid angiopathy is caused by cerebrovascular amyloid deposition which leads to microaneurysms and an increased tendency to haemorrhage (microhaemorrhages or larger intracerebral parenchymal haemorrhages). Increased level of FAM19A5 is associated with cerebral small vessel disease and leads to a better outcome. Haemosiderin deposition and vascular pathology in the putamen were quantified in 200 brains donated to the population-representative Medical Research Council Cognitive Function and Ageing Study. 10.1161/STROKEAHA.108.516286. In this review, we aim to summarize the current knowledge on the pathophysiology and clinical implications of MBs, with special emphasis on the links between lobar MBs, cerebral amyloid angiopathy and Alzheimers disease. It was also seen that the combination of multiple MBs and retinopathy increased the odds ratio of vascular dementia: 3.10; 95% confidence interval (CI) 1.11 to 8.62 [46]. 2007, 26: 823-837. Superficial hemosiderosis of the 'classical type' is a rare but potentially serious condition resulting from leptomeningeal hemosiderin accumulation on the surface of the cerebellum, around the cranial nerves and spinal cord. The source of hemorrhage is not apparent in approximately 50% of patients despite extensive examination. At present, it is indirect evidence from population-based studies that mostly supports the associations between lobar/deep MBs and CAA/HV. Some people have no damage at all, whereas others have some damage. 10.1016/S1474-4422(09)70013-4. Direct bleeding into the tissues that is followed by breakdown of red blood cells and release of iron to the . eCollection 2022. 22 Rivkin et al 40 measured T2* values in brain tissue . In the case of the cortical type, hemosiderosis is located supratentorially (above the cerebral convexity), and a cerebral amyloid angiopathy is regarded as an aetiological key factor, particularly in older patients. As pointed out in population-based studies, lobar MBs are not associated with classic vascular risk factors and show weak associations with other classic SVD markers. sharing sensitive information, make sure youre on a federal ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Because of the differential topographic preference of CAA and HV, MBs associated with these two entities could be expected to follow similar distributions: strictly lobar (cortical-subcortical regions of brain lobes and cerebellum) in CAA; strictly deep (deep white matter, basal ganglia, thalamus, brainstem, cerebellum) in HV; and mixed (lobar and deep regions) when an individual has coexisting CAA and HV. 2012, 43: 1505-1510. Most cases of renal hemosiderosis do not cause kidney damage. The .gov means its official. Stroke. (B) Isolated deep microbleed in the lateral aspect of the right thalamus. Think of getting a glob of ketchup on a white shirt. It is thus a hopeful treatment option for SS. . Interestingly, in individuals with executive dysfunction, MBs were predominantly located in the frontal lobes and basal ganglia, areas classically considered the neuroanatomical substrate for executive function. Google Scholar. This phenomenon, called susceptibility effect, is the basis of T2*-gradient recalled echo (GRE) imaging, which led to the definition of the current concept of radiological MBs [2] (Figure1). For instance, 7-Tesla MRI detects twice as many MBs in comparison to conventional 1.5-Tesla MRI [7]. Soo YO, Yang SR, Lam WW, Wong A, Fan YH, Leung HH, Chan AY, Leung C, Leung TW, Wong LK: Risk vs benefit of anti-thrombotic therapy in ischaemic stroke patients with cerebral microbleeds. Hemosiderosis is a term used for excessive accumulation of iron deposits called hemosiderin in the tissues. High Signal Intensity of the Cochlear Modiolus on Unenhanced T1-Weighted Images in Classical Infratentorial Superficial Siderosis. 2022 Jan 29;81(2):97-105. doi: 10.1093/jnen/nlab125. 10.1212/WNL.0b013e3181e396ea. 2010;74(17):1346-50. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Article 2011, 42: 638-644. HHS Vulnerability Disclosure, Help Stroke. The pathologic study of one of these cases [61] suggested that an inflammatory reaction had been triggered by the immunization agent and targeted -amyloid, both in tissue plaques and vessels [62]. This article will provide an overview of the signs, symptoms, causes, risk factors, diagnosis, and treatment of superficial siderosis. Please enable it to take advantage of the complete set of features! These findings fit well with the notion of lobar and deep MBs associated with HV and CAA, respectively. Altmann-Schneider I, Trompet S, de Craen AJ, van Es AC, Jukema JW, Stott DJ, Sattar N, Westendorp RG, van Buchem MA, van der Grond J: Cerebral microbleeds are predictive of mortality in the elderly. In a subsequent study based on the same population, lobar MBs were seen to occur significantly more often in the temporal lobe [23], one of the regions severely affected by CAA. 10.1159/000092958. Beta-propeller protein-associated neurodegeneration (BPAN) is the most recently identified subtype of neurodegeneration with brain iron accumulation (NBIA), being unique with respect to the underlying disease genetics, the associated clinical presentation, and the suggested pathomechanism. Cordonnier C, van der Flier WM, Sluimer JD, Leys D, Barkhof F, Scheltens P: Prevalence and severity of microbleeds in a memory clinic setting. Since lobar MBs in the context of AD are interpreted as markers of advanced CAA, lobar MB carriers (especially those with multiple MBs) are currently excluded from immunization trials as a safety measure [63]. Hardy J, Selkoe DJ: The amyloid hypothesis of Alzheimers disease: progress and problems on the road to therapeutics. Individuals with MBs had a much higher prevalence of executive dysfunction than those without MBs (60% versus 30%, P=0.03). In these studies, two main forms of vasculopathies have been associated with MBs in the aging brain: CAA and hypertensive vasculopathy (HV). This deposition gradually occurs and has been mainly attributed to dysfunctional brain iron regulatory mechanisms including abnormal permeability of the vessel walls and glial cell dysfunction (McCarthy and Kosman 2014 ). 10.1212/WNL.43.10.2073. However, a larger study using specific neuropsychological assessments did not find any relationship between MBs and worse cognitive performance [50]. Tidsskriftet redigeres etter redaktrplakaten. For the cortical type, (transient) focal neurological symptoms are found, but also development of dementia (1). Pathology of the Vestibulocochlear Nerve. Hemosiderosis can result from. Indeed, global cognitive tests (like MMSE) may not capture impairment in certain domains such as executive function. Careers. Science. Neurol Med Chir. Apart from offering hints on AD pathophysiology, their presence may modify the course of the disease and even the response to new immunotherapeutic agents. The deposition of hemosiderin and other blood breakdown products is an established irritant to cerebral tissues. The most common causes of hemorrhage in the "localized" type are cerebral amyloid angiopathy and/or Alzheimer's disease. van der Vlies AE, Goos JD, Barkhof F, Scheltens P, van der Flier WM: Microbleeds do not affect rate of cognitive decline in Alzheimer disease. Hemosiderin deposition was found to be increasingly widespread in these patients; however, the specific regions affected varied from case to case. Sergi Martinez-Ramirez. 2011, 134: 335-344. In the literature, the risk/benefit ratio of anti-thrombotic drugs in individuals with MBs is controversial, and no formal contraindications in this respect exist. 10.1161/01.STR.0000126807.69758.0e. These two factors may explain the impact of baseline identification of MBs on future neurological events and mortality. Videre beskrives at man ogs har gjort CT caput, spinalpunksjon, EEG og MR caput i utredningen, og, Nyeste ledige stillinger fra legejobber.no. Causes of hemorrhage in the "classical" type include tumor, vascular abnormality, injury, and dural defect. Accessibility In this case, low MB counts may have prevented this study from identifying associations. G0800380/MRC_/Medical Research Council/United Kingdom, MC_U105292687/MRC_/Medical Research Council/United Kingdom, MR/L016451/1/MRC_/Medical Research Council/United Kingdom, G0900582/MRC_/Medical Research Council/United Kingdom, G1100540/MRC_/Medical Research Council/United Kingdom, G0900652/MRC_/Medical Research Council/United Kingdom, G9901400/MRC_/Medical Research Council/United Kingdom, G0400074/MRC_/Medical Research Council/United Kingdom, G0502157/MRC_/Medical Research Council/United Kingdom, Fazekas F, Kleinert R, Roob G, Kleinert G, Kapeller P, Schmidt R, Hartung HP. Of 58 patients, deposition was found in the frontal (41.3%), temporal (39.7%), parietal (43.1%), and occipital areas (20.7%) and in the sylvian fissure (65.5%). 10.1161/01.STR.30.8.1637. The patient died a few months after the diagnosis was made. PubMed The Rotterdam Scan Study [16] reported that healthy older individuals with strictly lobar MBs have an exceedingly high frequency of the apolipoprotein E-4 (APOE-4) allele (compared with patients with MBs not strictly confined to lobar regions), which is in agreement with increased APOE-4 frequencies seen in patients with probable CAA. 10.1212/WNL.56.4.537. The cautious approach to anti-thrombotic therapy in patients with these symptomatic episodes can be extended to all patients exhibiting MBs. Google Scholar. Hemosiderin staining can occur in people with venous ulcers, which are slow-healing or non-healing wounds caused by blood pooling in the veins. The findings are characteristic, with all pial and ependymal surfaces coated with low signal hemosiderin, particularly those of the brainstem and cerebellum (the cerebellar vermis and folia are excellent locations for identifying subtle deposits). Overall, there is a male predilection (M:F 3:1) 2,5. . Kumar N, Miller GM, Piepgras DG et-al. [PubMed][CrossRef]. Hemosiderin hyperpigmentation can develop in brown or golden-brown-yellow patches on the skin. 2006 Apr 25;66(8):1144-52. doi: 10.1212/01.wnl.0000208510.76323.5b. Nakata-Kudo Y, Mizuno T, Yamada K, Shiga K, Yoshikawa K, Mori S, Nishimura T, Nakajima K, Nakagawa M: Microbleeds in Alzheimer disease are more related to cerebral amyloid angiopathy than cerebrovascular disease. Ann N Y Acad Sci. The link you have selected will take you to a third-party website. Stroke. Clipboard, Search History, and several other advanced features are temporarily unavailable. Although the underlying mechanism is still a matter of debate, several clinical reports suggest that MBs might cause acute transient focal neurological episodes (TFNEs) [29, 30]. Hemosiderosis can result from, Direct bleeding into the tissues that is followed by breakdown of red blood cells and release of iron to the tissues, Destruction of red blood cells within the blood vessels, leading to release of iron into the blood followed by accumulation of iron inside the kidneys as the kidneys filter waste from the blood. AVM Accounts for 1.5-4% of all brain masses; most supratentorial Admixture of arteries, veins, and intermediate- sized vessels Vessels are separated by gliotic neural parenchyma Foci of mineralization and hemosiderin deposi- tion are common Typically superficial, wedge-shaped, with the apex directed toward the ventricle Commonly found in . These phenomena provide a scientific basis to support direct clinical effects of MBs, beyond their associations with particular vasculopathies. 2010, 74: 1954-1960. 2003, 9: 448-452. 2004, 62: 72-76. Offenbacher H, Fazekas F, Schmidt R, Koch M, Fazekas G, Kapeller P: MR of cerebral abnormalities concomitant with primary intracerebral hematomas. Check for errors and try again. Von Sattel JP, Myers RH, Hedley-Whyte ET, Ropper AH, Bird ED, Richardson EP: Cerebral amyloid angiopathy without and with cerebral hemorrhages: a comparative histological study. Pettersen JA, Sathiyamoorthy G, Gao FQ, Szilagyi G, Nadkarni NK, St George-Hyslop P, Rogaeva E, Black SE: Microbleed topography, leukoaraiosis, and cognition in probable Alzheimer disease from the Sunnybrook dementia study. 4. The Whole Picture: From Isolated to Global MRI Measures of Neurovascular and Neurodegenerative Disease. Increase in hemosiderin deposition around the lesion typically represents the hemorrhage transitioning from an acute to chronic phase, and the extent of hemosiderin deposition is related to the number of hemorrhage . eCollection 2021. PubMed Poels MM, Ikram MA, van der Lugt A, Hofman A, Krestin GP, Breteler MM, Vernooij MW: Incidence of cerebral microbleeds in the general population: the Rotterdam Scan Study. med., senior consultant. Diagnostic Imaging: Head and Neck. Deferiprone, which is a lipid-soluble iron chelator that can penetrate the blood-brain barrier, is reportedly effective at improving the clinical symptoms and deposition of hemosiderin. Choi P, Ren M, Phan TG, Callisaya M, Ly JV, Beare R, Chong W, Srikanth V: Silent infarcts and cerebral microbleeds modify the associations of white matter lesions with gait and postural stability: population-based study. 2009, 30: 338-343. 1999;20(7):1245-8. Kirsch W, McAuley G, Holshouser B, Petersen F, Ayaz M, Vinters HV, Dickson C, Haacke EM, Britt W, Larseng J, Kim I, Mueller C, Schrag M, Kido D: Serial susceptibility weighted MRI measures brain iron and microbleeds in dementia. Pract Neurol. Hemosiderin is a stain, left behind after a brain bleed, even after though the blood is reabsorbed into the blood system. Article Tanaka A, Ueno Y, Nakayama Y, Takano K, Takebayashi S: Small chronic hemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas. Mutations in X-chromosomal WDR45 arise de novo; however, the dominant pattern of inheritance is unusual . From a pathological point of view, MBs are tiny deposits of blood degradation products (mainly hemosiderin) contained within macrophages and in close spatial relationship with structurally abnormal vessels. Neurology. These data are of clinical relevance, suggesting that basal ganglia MRI microbleeds may be a surrogate for ischaemic small vessel disease rather than exclusively a haemorrhagic diathesis. AJNR Am J Neuroradiol. 2009, 40: 2382-2386. 8600 Rockville Pike 2013, 44: 2782-2786. In fact, experimental studies have shown that MBs may transiently affect the function of the nearby cells because of an inhibition of stimulus-evoked calcium responses [31]. An early study prospectively analyzed patients with ischemic stroke, myocardial infarction (MI), or peripheral arterial disease and found evidence of local hemosiderin deposition to be present in 31 of 221 patients (14%). 2007 Apr;64(4):491-6. doi: 10.1001/archneur.64.4.491. Brain 2015; 138: 2126 - 39. Ann Neurol. 10.1161/STROKEAHA.108.531343. Geriatric neurology. Manage cookies/Do not sell my data we use in the preference centre. 2011, 68: 656-659. MRI-visible perivascular space location is associated with Alzheimer's disease independently of amyloid burden. 1991, 30: 637-649. Stroke. View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, dural defect with spinal CSF collections/spinal cyst, fragile capillary regrowth after brain surgery, cerebellar bleeding following craniectomy, spinal surgery or lumbar puncture. Lee SH, Bae HJ, Kwon SJ, Kim H, Kim YH, Yoon BW, Roh JK: Cerebral microbleeds are regionally associated with intracerebral hemorrhage. Cianchetti FA, Kim DH, Dimiduk S, Nishimura N, Schaffer CB: Stimulus-evoked calcium transients in somatosensory cortex are temporarily inhibited by a nearby microhemorrhage. The pathological and radiological relationship between these findings is not resolved. Stephan Johannes Schler, Kjell Arne Kvistad. 10.1161/STROKEAHA.113.002267. 2018 Jul;41(4):490-495. doi: 10.1080/10790268.2017.1329053. The main limitation of these studies was the use of the Mini-Mental State Examination (MMSE) as the main cognitive outcome measure. doi: 10.7717/peerj.13101. Associations and implications of cerebral microbleeds. A cause of recurrent subarachnoid hemorrhage is present in ~50% of cases 1-6,8: Usually unrewarding; will not demonstrate a point of bleeding 1. Higher levels of putamen haemosiderin correlated with more CMB (P < 0.003). doi: 10.1136/bcr-2019-230431. 2010, 41: 184-186. Lanska DJ. According to a follow-up report from the Rotterdam Scan Study, incident lobar and deep MBs have different risk factors [35], similar to what had been observed with baseline MBs [16]. Since HV is secondary to a systemic process (hypertension), high cardiovascular mortality is expected in the context; however, CAA is a primary brain vasculopathy, with no extracerebral manifestations. If you do not see the PDF file or want to save the file, you can right-click on the PDF icon. Lee SH, Ryu WS, Roh JK: Cerebral microbleeds are a risk factor for warfarin-related intracerebral hemorrhage. Cerebral microbleeds (MBs) are small chronic brain hemorrhages which are likely caused by structural abnormalities of the small vessels of the brain. Prevalence of Superficial Siderosis in Patients with Cerebral Amyloid Angiopathy. Microhaemorrhages in connection with a previous haemorrhage are typical of amyloid angiopathy. (2010) ISBN: 9780781791861 -. and transmitted securely. 2019;1205:25-53. doi: 10.1007/978-3-030-31904-5_3. Depending on the amount of iron that remains in the lungs people may have no problems or varying degrees of lung damage. The https:// ensures that you are connecting to the Neurology. Organs may be, but are usually not, damaged by the iron deposits. Regardless of the exact type of lesion involved, the investigation for evidence of chronic hemorrhages in TIA seems crucial, as the simple initiation of anti-thrombotic therapy could have undesirable effects in cases with TFNE. doi: 10.5114/pjr.2021.110650. The medical history was potentially consistent with Creutzfeldt-Jakob disease, but the 143-3protein in cerebrospinal fluid, which is used as a biomarker for the condition, was normal. For the cortical type, (transient) focal neurological symptoms are found, but also development of dementia (1). Man fr i denne artikkelen inntrykk av at CT thorax, abdomen og bekken inngr i utredningen av demens hos en pasient i 90-rene med tidligere hjernebldning. Symptoms occur when these hemorrhages cause sufficient irritation in the surrounding brain to produce seizure activity or when the lesions reach sufficient size to compress adjacent neurological structures. These results suggested that (a) MBs may actually have a negative effect on cognition, independently of other concurrent vascular lesions, and (b) there seems to be an anatomical correlation between the distribution of MBs and the cognitive domains affected, suggesting a direct damage of MBs over the tissue as the pathogenic mechanism. Also, CAA is often reported in autopsies, which by definition reflect end-stage disease, whereas MB imaging is performed mostly in earlier stages of the disease. Nandigam RN, Viswanathan A, Delgado P, Skehan ME, Smith EE, Rosand J, Greenberg SM, Dickerson BC: MR imaging detection of cerebral microbleeds: effect of susceptibility-weighted imaging, section thickness, and field strength.

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