engleski

Spontaneous brain microbleeds

The neuroradiological techniques development leads to the increased detection of spontaneous brain microbleeds (SBMB) in a considerable number of people with vascular risk factors, with different types of stroke, some types of dementia, but also in healthy elderly population. Despite the numerous studies, the SBMB still represent clinical dilemmas and pathophysiologic unknowns. The SBMB are seen on MRI gradient echo (GE) T2-weighted sequences as small, hypointensity round or oval areas (2-5 mm in diameter) that correspond to hemosiderin deposits in cerebral perivascular spaces. They are the result of the rupture of cerebral small vessel and are often clinically asymptomatic. It is believed that the brain microangiopathy is unferlying SBMB, so they can be cosidered an important diagnostic biomarker of the cerebral small-vessels disease, such as hypertensive angiopathy, cerebral amiloid angiopathy (CAA) or arteriosclerosis. The presence of SBMB with the presence of other forms of cerebral microangiopathy (silent brain infarct, lacunar stroke, leukoaraiosis) indicates that they may share a common pathophysiological mechanism of microvascular endothelial damage. Past studies have confirmed the high prevalence of the SBMB in patients with intracerebral macrobleeds (71%). It is considered that the SBMB can be the predictor of a subsequent stroke, particularly hemorrhagic stroke. According to some studies, the SBMB etiology can be confirmed according to their localization. Cortical and subcortical microbleeds indicate CAA, while the deep or infratentorial localization are the result of hypertension and aterosclerotic microangiopathy. The presence of BMB in case of CAA is in the corelation with the macrobleed relapse risk and disease progress. BMB can be also presentin patients with some form of hereditary cerebral angiopathy, like CADASIL. In conclusion, based on past studies, SBMB might provide useful diagnostic and prognostic information, potentially with the therapeutic implications for stroke treatment.

cerebral microbleeds; small-vessels disease; stroke

nije evidentirano