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August 2016

Cerebral Microbleeds, Cognition, and Therapeutic Implications

Author Affiliations
  • 1Department of Translational Science & Molecular Medicine, Michigan State University College of Human Medicine, Grand Rapids
  • 2Division of Stroke and Vascular Neurology, Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan
JAMA Neurol. 2016;73(8):908-910. doi:10.1001/jamaneurol.2016.1388

A recent major clinical advance in magnetic resonance imaging (MRI) of the brain is the development of paramagnetic-sensitive sequences such as T2-weighted gradient-recalled echo and susceptibility-weighted images for the detection of cerebral microbleeds (CMBs).1,2 On brain MRI, CMBs are small (≤5 to 10 mm in diameter), round, dark-signaled lesions that consist of extravasation of blood components through fragile microvascular walls that neuropathologically represent hemosiderin-laden macrophages.2,3 Magnetic resonance imaging–detected CMBs are common in elderly individuals, coexist with ischemic stroke and intracerebral hemorrhage (ICH) of various types, and are associated with cardiovascular risks, such as hypertension and smoking, and lobar hemorrhage when underlying cerebral amyloid angiopathy is found.4 Furthermore, CMBs may have a role in determination of cognitive outcome, and because of their relationship with ICH, their presence challenges physicians to make decisions regarding administration of antithrombotics, acute thrombolytics, and other cardiovascular therapies that may lead to brain hemorrhage. In this editorial, we review an important study on the occurrence of CMBs and cognitive impairment and dementia5 and discuss the implications of CMBs on management decisions in clinical practice.

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