Author Affiliations: Departments of Epidemiology (Drs Poels, Mesker, Ikram, Breteler, and Vernooij) and Radiology (Drs Poels, Ikram, and Vernooij), Erasmus University Medical Center, Rotterdam, the Netherlands.
We agree with Wu and Zhang that, although the evidence for the relation between lobar CMBs and cerebral amyloid angiopathy is accumulating,1,2 direct evidence from pathological studies is still limited.3 We can, therefore, not exclude that some factor other than cerebral amyloid angiopathy might account for the distribution of lobar CMBs in our general elderly population. The concern expressed that there may be overlap between microbleeds and lacunar infarcts in our study is, in our opinion, unfounded. Indeed, we and others have previously shown lacunar infarcts and cerebral microbleeds to coexist frequently.2,4,5 This is especially true for microbleeds in deep and infratentorial brain regions, which are thought to be a hallmark of hypertensive vasculopathy, and much less so for those in lobar regions.2,4,5
Poels MMF, Mesker DJ, Ikram MA, Breteler MMB, Vernooij MW. Microbleeds and Lacunar Infarcts in the Rotterdam Scan Study—Reply. Arch Neurol. 2011;68(10):1344-1345. doi:10.1001/archneurol.2011.231