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Images in Neurology
January 2017

Imaging the Acute Formation of a Cortical Microbleed in Cerebral Amyloid Angiopathy

Author Affiliations
  • 1Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
JAMA Neurol. 2017;74(1):120-121. doi:10.1001/jamaneurol.2016.3445

An 80-year-old cognitively impaired man with multiple strictly lobar cerebral microbleeds (CMBs) diagnosed with probable cerebral amyloid angiopathy (CAA) 4 years earlier was seen at an outpatient clinic for dizziness in the context of global worsening of cognitive function. A magnetic resonance image (MRI) was acquired (Figure, A) and demonstrated a punctuate lesion in the left superior parietal lobule, with typical T2* gradient echo characteristics of a CAA-related CMB (round, hypointense, <5 mm in diameter, and cortical or immediately subcortical). This lesion had a hyperintense signal on both T2 fluid-attenuated inversion recovery and T1-weighted sequences, suggesting the hemorrhage occurred within 7 to 28 days of the scan (late subacute stage). A follow-up scan acquired 1 year later showed complete resolution of the T1 and T2 hyperintensity and a susceptibility artifact approximately unchanged in size (Figure, G).

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