Cerebral microhemorrhage

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Cerebral microhaemorrhages, or cerebral microbleeds,are small focal intracerebral haemorrhages, often only visible on susceptibility-sensitive MRI sequences.

Pathology

Common aetiologies

cavernous malformations ^1,⁸
- especially Zabramski classification type IV malformations
- causes include multiple (familial) cavernous malformation syndrome and post-cerebral radiotherapy
cerebral amyloid angiopathy^1,⁸
- typically involves the grey-white matter junction; usually spares the basal ganglia
chronic hypertensive encephalopathy ^1,⁸
- typically involve the basal ganglia, thalami as well as brainstem, cerebellum and corona radiata
diffuse axonal injury (DAI) and other trauma ^1,8
- typically involves the grey-white matter junction, splenium of the corpus callosum, and dorsolateral brainstem

Less common aetiologies

acute haemorrhagic leukoencephalitis (AHLE) ⁸
amyloid related imaging abnormalities (ARIA-H)¹⁶
CADASIL ^1,8
- microhaemorrhages have been reported to occur in 25–70% of cases without a characteristic distribution
cerebral hyperperfusion syndrome ¹¹
cerebral vasculitis (primary or secondary) ^1,8
- microhaemorrhages usually located at the corticomedullary junction
COL4A1 brain small-vessel disease
- microhaemorrhages have been reported in up to 53% of cases, characteristically in the centrum semiovale, deep gray matter, or brainstem ^5,8
haemorrhagic micrometastases ^1,8
- especially melanoma or renal cell carcinoma
hypoxia (e.g. acute respiratory distress syndrome, high-altitude exposure, being critically ill) ^8-10,15
intracranial embolism
- fat embolism
  - usually from fractures ^4,^8,14
- gas embolism ^6,7
  - many causes including: intravenous catheter placement, decompression sickness, extracorporeal membrane oxygenation, hydrogen peroxide ingestion, etc.
- septic embolism
  - usually from infective endocarditis ^3,⁸
intracranial infection (e.g. cerebral malaria, mycotic aneurysm) ⁸
intravascular lymphoma ⁸
neurosarcoidosis ^12,13
posterior reversible encephalopathy syndrome (PRES) ⁸
progressive facial hemiatrophy (PFHA) ^1,8
radiation-induced cerebral vasculopathy ^1,8
thrombotic microangiopathies (e.g. haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP)) ⁸

Radiographic features

MRI

Cerebral microhaemorrhages are only seen on MRI and are best seen on susceptibility weighted T2* sequences such as gradient-recalled echo (GRE) and susceptibility weighted imaging (SWI).

They appear as conspicuous 2-10 mm punctate regions of signal drop out with blooming artifact. This blooming grossly overestimates the size of the lesions, thus they are usually inapparent on other MRI sequences and CT.

Differential diagnosis

artificial heart valve metallic emboli (very rare)
pneumocephalus (very rare without preceding surgery) ²
flow voids of veins ⁸
intracranial calcification ⁸

-<p><strong>Cerebral microhaemorrhages</strong>, or<strong> cerebral microbleeds</strong>,<strong> </strong>are small focal intracerebral haemorrhages, often only visible on <a href="/articles/susceptibility-weighted-imaging-1">susceptibility-sensitive MRI sequences</a>.</p><h4>Pathology</h4><h5>Common aetiologies</h5><ul>
+<p><strong>Cerebral microhaemorrhages</strong>, or<strong> cerebral microbleeds</strong>,<strong> </strong>are small focal <a title="Intracerebral haemorrhages" href="/articles/intracerebral-haemorrhage">intracerebral haemorrhages</a>, often only visible on <a href="/articles/susceptibility-weighted-imaging-1">susceptibility-sensitive MRI sequences</a>.</p><h4>Pathology</h4><h5>Common aetiologies</h5><ul>
-<a href="/articles/hypertensive-microangiopathy">chronic hypertensive encephalopathy</a> <sup>1,</sup><sup>8</sup><ul><li>typically involve the basal ganglia, thalami as well as brainstem, cerebellum and <a title="Corona radiata" href="/articles/corona-radiata">corona radiata</a>
+<a href="/articles/hypertensive-microangiopathy">chronic hypertensive encephalopathy</a> <sup>1,</sup><sup>8</sup><ul><li>typically involve the basal ganglia, thalami as well as brainstem, cerebellum and <a href="/articles/corona-radiata">corona radiata</a>
-<a href="/articles/diffuse-axonal-injury">diffuse axonal injury (DAI)</a> and other trauma <sup>1,8</sup><ul><li>typically involves the <a href="/articles/grey-white-differentiation">grey-white matter junction</a>, splenium of the <a title="Corpus callosum" href="/articles/corpus-callosum">corpus callosum</a>, and dorsolateral brainstem </li></ul>
+<a href="/articles/diffuse-axonal-injury">diffuse axonal injury (DAI)</a> and other trauma <sup>1,8</sup><ul><li>typically involves the <a href="/articles/grey-white-differentiation">grey-white matter junction</a>, splenium of the <a href="/articles/corpus-callosum">corpus callosum</a>, and dorsolateral brainstem </li></ul>
+<a href="/articles/amyloid-related-imaging-abnormalities-aria">amyloid related imaging abnormalities (ARIA-H)</a> <sup>16</sup>
+</li>
+<li>
-</ul><h4>Radiographic features</h4><p>Cerebral microhaemorrhages are only seen on <a href="/articles/mri-2">MRI</a> and are best seen on susceptibility weighted <a href="/articles/t2-relaxation-1">T2*</a> sequences such as <a href="/articles/gradient-echo-sequences-1">gradient-recalled echo (GRE)</a> and <a href="/articles/susceptibility-weighted-imaging-1">susceptibility weighted imaging (SWI)</a>.</p><p>They appear as conspicuous 2-10 mm punctate regions of signal drop out with <a href="/articles/blooming-artifact-mri">blooming artifact</a>. This blooming grossly overestimates the size of the lesions, thus they are usually inapparent on other MRI sequences and CT.</p><h4>Differential diagnosis</h4><ul>
+</ul><h4>Radiographic features</h4><h5>MRI</h5><p>Cerebral microhaemorrhages are only seen on <a href="/articles/mri-2">MRI</a> and are best seen on susceptibility weighted <a href="/articles/t2-relaxation-1">T2*</a> sequences such as <a href="/articles/gradient-echo-sequences-1">gradient-recalled echo (GRE)</a> and <a href="/articles/susceptibility-weighted-imaging-1">susceptibility weighted imaging (SWI)</a>.</p><p>They appear as conspicuous 2-10 mm punctate regions of signal drop out with <a href="/articles/blooming-artifact-mri">blooming artifact</a>. This blooming grossly overestimates the size of the lesions, thus they are usually inapparent on other MRI sequences and CT.</p><h4>Differential diagnosis</h4><ul>

References changed:

16. Sperling R, Jack C, Black S et al. Amyloid-Related Imaging Abnormalities in Amyloid-Modifying Therapeutic Trials: Recommendations from the Alzheimer's Association Research Roundtable Workgroup. Alzheimers Dement. 2011;7(4):367-85. <a href="https://doi.org/10.1016/j.jalz.2011.05.2351">doi:10.1016/j.jalz.2011.05.2351</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21784348">Pubmed</a>

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