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April 2017

Cerebral Cortical Microinfarcts on 3-T Magnetic Resonance Imaging: A New Tool in the Study of Cerebrovascular Ischemia

Author Affiliations
  • 1Emeritus, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Neurol. 2017;74(4):385-386. doi:10.1001/jamaneurol.2016.5555

Cerebral cortical microinfarcts (CMIs) are one of several neuropathologic manifestations of small-vessel cerebral ischemia, along with lacunar infarcts and white matter gliosis.1,2 They are defined as small (usually <1 mm) regions of ischemic change found in the cerebral cortex on microscopic examination, which are not readily visible on gross examination or standard 1.5-T magnetic resonance imaging (MRI). They are described microscopically as small foci of neuronal loss, gliosis, pallor, or even small cysts. The presence of CMIs is relatively common in elderly individuals without dementia (24%) but more common in autopsies of patients diagnosed with Alzheimer disease (43%) or vascular dementia (62%).1 Most patients with CMIs have multiple lesions. They can be found in all regions of the brain but are most common in the cerebral cortex and watershed areas.1 The exact pathophysiologic origin of CMIs is uncertain but may be heterogeneous, with microembolism, microthrombosis, and foci of inflammation considered possible causative factors.2