Cerebral microhemorrhage
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Cerebral microhaemorrhages, or cerebral microbleeds,are small focal cerebral haemorrhages, often only visible on susceptibility weighted-sensitive MRI sequences.
Pathology
Common aetiologies
-
cavernous malformations8
- especially Zabramski classification type IV malformations
- causes include multiple (familial) cavernous malformation syndrome
-
and post
cerebral-cerebral radiotherapy
-
cerebral amyloid angiopathy (common)8
- typically involves the grey-white matter junction; usually spares the basal ganglia
-
chronic hypertensive encephalopathy (common)8
- typically involve the basal ganglia, thalami as well as
brain stembrainstem, cerebellum and corona radiata
- typically involve the basal ganglia, thalami as well as
-
diffuse axonal injury (DAI) and other trauma 1,8
- typically involves the grey-white matter junction, splenium of the corpus callosum, and dorso-lateral brainstem
Less common aetiologies
- acute haemorrhagic leukoencephalitis (AHLE)8
-
CADASIL
(rare)8- microhaemorrhages have been reported to occur in 25–70% of cases without a characteristic distribution
-
cerebral vasculitis (primary or secondary)8
- microhaemorrhages usually located at the corticomedullary junction
-
COL4A1 brain small-vessel disease
(rare)- microhaemorrhages have been reported in up to 53% of cases, characteristically in the centrum semiovale, deep gray matter, or brainstem 5,8
-
haemorrhagic micrometastases
(rare)8- melanoma or renal cell carcinoma
- hypoxia (e.g. acute respiratory distress syndrome) 8
- intracranial embolism:
-
fat embolism
- usually from fractures8
- air embolism 6,7
- many causes including: intravenous catheter placement, decompression sickness, extracorporeal membrane oxygenation, hydrogen
peroxydeperoxide ingestion, etc.
- many causes including: intravenous catheter placement, decompression sickness, extracorporeal membrane oxygenation, hydrogen
- septic embolism
- usually from infective endocarditis8
-
fat embolism
- intracranial infection (e.g. cerebral malaria) 8
- intravascular lymphoma8
- posterior reversible encephalopathy syndrome (PRES) 8
-
progressive facial hemiatrophy (PFHA)
(very rare)8 septic and fat emboli-
trauma includingdiffuse axonal injury (DAIthrombotic microangiopathies (e.g. haemolytic uraemic syndrome and thrombotic thrombocytopaenic purpura)18typically involves the grey–white matter junction, splenium of the corpus callosum, and dorso-lateral brainstem
Radiographic features
Cerebral microhaemorrhages are best seen on susceptibility weighted T2* sequences such as gradient-recalled echo (GRE), and and susceptibility weighted imaging (SWI).
They appear as conspicuous 2-10 millimeter punctate regions of signal drop out with blooming artifact. This blooming grossly overestimates the size of the lesions, and they are usually inapparent on other sequences. As such the sometimes used definition of 5 mm or less in size is difficult as it is sequence dependent, and should not be applied to susceptibility weighted sequences.
Differential diagnosis
- artificial heart valve metallic emboli (very rare)
- pneumocephalus (very rare without proceeding surgery) 2
- flow voids of veins 8
- intracranial calcification 8
-<p><strong>Cerebral microhaemorrhages</strong>, or<strong> microbleeds</strong>,<strong> </strong>are small focal cerebral haemorrhages, often only visible susceptibility weighted MRI sequences.</p><h4>Common aetiologies</h4><ul>- +<p><strong>Cerebral microhaemorrhages</strong>, or<strong> cerebral microbleeds</strong>,<strong> </strong>are small focal cerebral haemorrhages, often only visible on susceptibility-sensitive MRI sequences.</p><h4>Pathology</h4><h5>Common aetiologies</h5><ul>
-<a href="/articles/cerebral-cavernous-venous-malformation">cavernous malformations</a><ul>-<li><a href="/articles/familial-multiple-cavernous-malformation-syndrome">multiple (familial) cavernous malformation syndrome</a></li>-<li>post cerebral radiotherapy </li>- +<a href="/articles/cerebral-cavernous-venous-malformation">cavernous malformations</a> <sup>8</sup><ul>
- +<li>especially <a href="/articles/zabramski-classification-of-cerebral-cavernous-malformations">Zabramski classification</a> type IV malformations</li>
- +<li>causes include <a href="/articles/familial-multiple-cavernous-malformation-syndrome">multiple (familial) cavernous malformation syndrome</a> and post-cerebral radiotherapy </li>
-<a href="/articles/cerebral-amyloid-angiopathy-1">cerebral amyloid angiopathy</a> (common)<ul><li>typically involves the grey-white matter junction; usually spares the basal ganglia</li></ul>- +<a href="/articles/cerebral-amyloid-angiopathy-1">cerebral amyloid angiopathy</a> (common) <sup>8</sup><ul><li>typically involves the grey-white matter junction; usually spares the basal ganglia</li></ul>
-<a href="/articles/hypertensive-microangiopathy">chronic hypertensive encephalopathy</a> (common)<ul><li>typically involve the basal ganglia, thalami as well as brain stem, cerebellum and corona radiata</li></ul>- +<a href="/articles/hypertensive-microangiopathy">chronic hypertensive encephalopathy</a> (common) <sup>8</sup><ul><li>typically involve the basal ganglia, thalami as well as brainstem, cerebellum and corona radiata</li></ul>
-</ul><h4>Less common aetiologies</h4><ul>-<a href="/articles/acute-haemorrhagic-leukoencephalitis">acute haemorrhagic leukoencephalitis</a> (AHLE)</li>- +<a href="/articles/diffuse-axonal-injury-dai">diffuse axonal injury</a> (DAI) and other trauma <sup>1,8</sup><ul><li>typically involves the grey-white matter junction, splenium of the corpus callosum, and dorso-lateral brainstem </li></ul>
- +</li>
- +</ul><h5>Less common aetiologies</h5><ul>
- +<li>
- +<a href="/articles/acute-haemorrhagic-leukoencephalitis">acute haemorrhagic leukoencephalitis</a> (AHLE) <sup>8</sup>
- +</li>
-<a href="/articles/cadasil">CADASIL</a> (rare)<ul><li>microhaemorrhages have been reported to occur in 25–70% of cases without a characteristic distribution</li></ul>- +<a href="/articles/cadasil">CADASIL</a> <sup>8</sup><ul><li>microhaemorrhages have been reported to occur in 25–70% of cases without a characteristic distribution</li></ul>
-<a href="/articles/cerebral-vasculitis">cerebral vasculitis</a> (primary or secondary)<ul><li>microhaemorrhages usually located at the corticomedullary junction</li></ul>- +<a href="/articles/cerebral-vasculitis">cerebral vasculitis</a> (primary or secondary) <sup>8</sup><ul><li>microhaemorrhages usually located at the corticomedullary junction</li></ul>
-<a href="/articles/col4a1-brain-small-vessel-disease">COL4A1 brain small-vessel disease</a> (rare)<ul><li>microhaemorrhages have been reported in up to 53% of cases, characteristically in the <a href="/articles/centrum-semiovale-1">centrum semiovale</a>, deep gray matter, or brainstem <sup>5</sup>- +<a href="/articles/col4a1-brain-small-vessel-disease">COL4A1 brain small-vessel disease</a><ul><li>microhaemorrhages have been reported in up to 53% of cases, characteristically in the <a href="/articles/centrum-semiovale-1">centrum semiovale</a>, deep gray matter, or brainstem <sup>5,8</sup>
-<a href="/articles/haemorrhagic-micrometastases">haemorrhagic micrometastases</a> (rare)<ul><li>melanoma or renal cell carcinoma</li></ul>- +<a href="/articles/haemorrhagic-micrometastases">haemorrhagic micrometastases</a> <sup>8</sup><ul><li>melanoma or renal cell carcinoma</li></ul>
- +</li>
- +<li>hypoxia (e.g. <a href="/articles/acute-respiratory-distress-syndrome-1">acute respiratory distress syndrome</a>) <sup>8</sup>
-<li>fat embolism<ul><li>usually from fractures</li></ul>- +<li>
- +<a href="/articles/cerebral-fat-embolism">fat embolism</a><ul><li>usually from fractures <sup>8</sup>
- +</li></ul>
-<li>air embolism <sup>6,7</sup><ul><li>many causes including: intravenous catheter placement, decompression sickness, extracorporeal membrane oxygenation, hydrogen peroxyde ingestion, etc.</li></ul>- +<li>air embolism <sup>6,7</sup><ul><li>many causes including: intravenous catheter placement, decompression sickness, extracorporeal membrane oxygenation, hydrogen peroxide ingestion, etc.</li></ul>
-<li>septic embolism<ul><li>usually from <a href="/articles/infective-endocarditis">infective endocarditis</a>- +<li>septic embolism<ul><li>usually from <a href="/articles/infective-endocarditis">infective endocarditis</a> <sup>8</sup>
- +<li>intracranial infection (e.g. <a href="/articles/cerebral-malaria-2">cerebral malaria</a>) <sup>8</sup>
- +</li>
-<a href="/articles/parry-romberg-syndrome">progressive facial hemiatrophy (PFHA)</a> (very rare)</li>-<li>septic and fat emboli</li>-<li>trauma including <a href="/articles/diffuse-axonal-injury-dai">diffuse axonal injury (DAI)</a> <sup>1</sup><ul><li>typically involves the grey–white matter junction, splenium of the corpus callosum, and dorso-lateral brainstem </li></ul>- +<a href="/articles/intravascular-lymphoma">intravascular lymphoma</a> <sup>8</sup>
-</ul><h4>Radiographic features</h4><p>Cerebral microhaemorrhages are best seen on susceptibility weighted T2* sequences such as <a href="/articles/gradient-echo-sequences-1">gradient echo</a> (GRE), and <a href="/articles/susceptibility-weighted-imaging-1">susceptibility weighted imaging</a> (SWI).</p><p>They appear as conspicuous punctate regions of signal drop out with <a href="/articles/blooming-artifact">blooming artifact</a>. This blooming grossly overestimates the size of the lesions, and they are usually inapparent on other sequences. As such the sometimes used definition of 5 mm or less in size is difficult as it is sequence dependent, and should not be applied to susceptibility weighted sequences. </p><h4>Differential diagnosis</h4><ul>- +<li>
- +<a href="/articles/posterior-reversible-encephalopathy-syndrome-1">posterior reversible encephalopathy syndrome</a> (PRES) <sup>8</sup>
- +</li>
- +<li>
- +<a href="/articles/parry-romberg-syndrome">progressive facial hemiatrophy</a> (PFHA) <sup>8</sup>
- +</li>
- +<li>thrombotic microangiopathies (e.g. <a href="/articles/haemolytic-uraemic-syndrome">haemolytic uraemic syndrome</a> and <a href="/articles/thrombotic-thrombocytopaenic-purpura">thrombotic thrombocytopaenic purpura</a>) <sup>8</sup>
- +</li>
- +</ul><h4>Radiographic features</h4><p>Cerebral microhaemorrhages are best seen on susceptibility weighted T2* sequences such as <a href="/articles/gradient-echo-sequences-1">gradient-recalled echo</a> (GRE) and <a href="/articles/susceptibility-weighted-imaging-1">susceptibility weighted imaging</a> (SWI).</p><p>They appear as conspicuous 2-10 millimeter punctate regions of signal drop out with <a href="/articles/blooming-artifact">blooming artifact</a>. This blooming grossly overestimates the size of the lesions, and they are usually inapparent on other sequences.</p><h4>Differential diagnosis</h4><ul>
- +<li>flow voids of veins <sup>8</sup>
- +</li>
- +<li>intracranial calcification <sup>8</sup>
- +</li>
References changed:
- 8. Sharma R, Dearaugo S, Infeld B, O'Sullivan R, Gerraty RP. Cerebral amyloid angiopathy: Review of clinico-radiological features and mimics. (2018) Journal of medical imaging and radiation oncology. <a href="https://doi.org/10.1111/1754-9485.12726">doi:10.1111/1754-9485.12726</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29604173">Pubmed</a> <span class="ref_v4"></span>
Systems changed:
- Central Nervous System
Images Changes:
Image 7 MRI (Gradient Echo) ( create )
Image 8 MRI (Gradient Echo) ( create )
Updates to Synonym Attributes
Title
was changed:
Cerebral microhemorrhagesmicrohaemorrhages
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