Cerebral microhemorrhage
Disclosures
- updated 18 Aug 2023:
Nothing to disclose
Updates to Article Attributes
Body
was changed:
Cerebral microhaemorrhages, or cerebral cerebral microbleeds,are small focal intracerebral haemorrhages, often only visible on susceptibility-sensitive MRI sequences.
Pathology
Common aetiologies
-
especially Zabramski classification
typetype IV malformationscauses include multiple (familial) cavernous malformation syndrome
andand post-cerebral radiotherapy
-
cerebral amyloid angiopathy
11,8typically involves the grey-white matter junction; usually spares the basal ganglia
-
chronic hypertensive encephalopathy1,8
typically involve the basal ganglia, thalami, brainstem, cerebellum and corona radiata
-
diffuse axonal injury (DAI)
andand other trauma 1,8typically involves the grey-white matter junction, splenium of the corpus callosum, and dorsolateral brainstem
Less common aetiologies
cathepsin A-related arteriopathy with strokes and leukoencephalopathy (CARASAL) 29,30
-
cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)1,8
microhaemorrhages have been reported to occur in 25–70% of cases without a characteristic distribution
cardiac bypass for surgery 15,31
-
cerebral vasculitis(primary or secondary)1,8
microhaemorrhages usually located at the corticomedullary junction
-
COL4A1 brain small-vessel disease 5,8
microhaemorrhages have been reported in up to 53% of cases, characteristically in the centrum semiovale, deep gray matter, or brainstem 5,8
-
haemorrhagic micrometastases1,8
especially melanoma or renal cell carcinoma
hypoxia and/or being critically ill (e.g. acute respiratory distress syndrome, high-altitude exposure, COVID-19)8-10
immune effector cell-associated neurotoxicity syndrome (ICANS) 32
-
intracranial 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 endocarditis3,8
-
intracranial infection (e.g. cerebral malaria, mycotic aneurysm)8
moyamoya disease and moyamoya syndrome22,23
neurosarcoidosis12,13
pontine autosomal dominant microangiopathy with leukoencephalopathy (PADMAL) 27,28
retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S)33,34
Sneddon syndrome18,19
thrombotic microangiopathies (e.g.haemolytic uraemic syndrome (HUS)
andand thrombotic thrombocytopenic purpura (TTP))8
Radiographic features
MRI
Cerebral microhaemorrhages are only seen on MRI and are only seen on susceptibility weighted T2* sequences such as gradient-recalled echo (GRE) and and susceptibility weighted imaging (SWI)24.
They appear as conspicuous 2-10 mm punctate regions of signal drop out with blooming artifact24. This blooming grossly overestimates the size of the lesions, thus they are usually inapparent on other MRI sequences and CT 24.
Differential diagnosis
artificial heart valve metallic emboli (very rare)8
punctate regions of signal loss in chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) 26
pneumocephalus (very rare without preceding surgery) 2
-<p><strong>Cerebral microhaemorrhages</strong>, or<strong> cerebral microbleeds</strong>,<strong> </strong>are small focal <a 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>-<li>-<p><a href="/articles/cerebral-cavernous-venous-malformation">cavernous malformations</a> <sup>1,8</sup></p>-<ul>-<li><p>especially <a href="/articles/zabramski-classification-of-cerebral-cavernous-malformations">Zabramski classification</a> type IV malformations</p></li>-<li><p>causes include <a href="/articles/familial-multiple-cavernous-malformation-syndrome">multiple (familial) cavernous malformation syndrome</a> and post-cerebral radiotherapy</p></li>-</ul>-</li>-<li>-<p><a href="/articles/cerebral-amyloid-angiopathy-1">cerebral amyloid angiopathy</a><sup> 1,8</sup></p>-<ul><li><p>typically involves the <a href="/articles/grey-white-differentiation">grey-white matter junction</a>; usually spares the <a href="/articles/basal-ganglia">basal ganglia</a></p></li></ul>-</li>-<li>-<p><a href="/articles/hypertensive-microangiopathy">chronic hypertensive encephalopathy</a> <sup>1,8</sup></p>-<ul><li><p>typically involve the basal ganglia, thalami, brainstem, cerebellum and <a href="/articles/corona-radiata">corona radiata</a></p></li></ul>-</li>-<li>-<p><a href="/articles/diffuse-axonal-injury">diffuse axonal injury (DAI)</a> and other trauma <sup>1,8</sup></p>-<ul><li><p>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 </p></li></ul>-</li>-</ul><h5>Less common aetiologies</h5><ul>-<li><p><a href="/articles/acute-haemorrhagic-leukoencephalitis">acute haemorrhagic leukoencephalitis (AHLE)</a> <sup>8</sup></p></li>-<li><p><a href="/articles/amyloid-related-imaging-abnormalities-aria">amyloid related imaging abnormalities (ARIA-H)</a> <sup>16</sup></p></li>-<li><p><a href="/articles/cathepsin-a-related-arteriopathy-with-strokes-and-leukoencephalopathy-carasal-1">cathepsin A-related arteriopathy with strokes and leukoencephalopathy (CARASAL)</a> <sup>29,30</sup></p></li>-<li>-<p><a href="/articles/cerebral-autosomal-dominant-arteriopathy-with-subcortical-infarcts-and-leukoencephalopathy-cadasil-1" title="Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)">cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)</a> <sup>1,8</sup></p>-<ul><li><p>microhaemorrhages have been reported to occur in 25–70% of cases without a characteristic distribution</p></li></ul>-</li>-<li><p><a href="/articles/cerebral-autosomal-recessive-arteriopathy-with-subcortical-infarcts-and-leukoencephalopathy-carasil" title="Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL)">cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL)</a> <sup>20,21</sup></p></li>-<li><p>cardiac bypass for surgery <sup>15,31</sup></p></li>-<li><p><a href="/articles/cerebral-hyperperfusion-syndrome">cerebral hyperperfusion syndrome</a> <sup>11</sup></p></li>-<li>-<p><a href="/articles/cerebral-vasculitis">cerebral vasculitis</a> (primary or secondary) <sup>1,8</sup></p>-<ul><li><p>microhaemorrhages usually located at the corticomedullary junction</p></li></ul>-</li>-<li>-<p><a href="/articles/col4a1-brain-small-vessel-disease">COL4A1 brain small-vessel disease</a> <sup>5,8</sup></p>-<ul><li><p>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 <a href="/articles/brainstem">brainstem</a> <sup>5,8</sup></p></li></ul>-</li>-<li>-<p><a href="/articles/haemorrhagic-micrometastases">haemorrhagic micrometastases</a> <sup>1,8</sup></p>-<ul><li><p>especially <a href="/articles/malignant-melanoma">melanoma</a> or <a href="/articles/renal-cell-carcinoma-1">renal cell carcinoma</a></p></li></ul>-</li>-<li><p>hypoxia and/or being critically ill (e.g. <a href="/articles/acute-respiratory-distress-syndrome-1">acute respiratory distress syndrome</a>, high-altitude exposure, <a href="/articles/covid-19-4">COVID-19</a>) <sup>8-10</sup></p></li>-<li><p><a href="/articles/immune-effector-cell-associated-neurotoxicity-syndrome-icans" title="Immune effector cell-associated neurotoxicity syndrome (ICANS)">immune effector cell-associated neurotoxicity syndrome (ICANS)</a> <sup>32</sup></p></li>-<li>-<p>intracranial embolism</p>-<ul>-<li>-<p><a href="/articles/cerebral-fat-embolism">fat embolism</a></p>-<ul><li><p>usually from fractures <sup>4,8,14</sup></p></li></ul>-</li>-<li>-<p>gas embolism <sup>6,7</sup></p>-<ul><li><p>many causes including: intravenous catheter placement, <a href="/articles/decompression-sickness">decompression sickness</a>, <a href="/articles/extracorporeal-membrane-oxygenation">extracorporeal membrane oxygenation</a>, <a href="/articles/hydrogen-peroxide">hydrogen peroxide ingestion</a>, etc.</p></li></ul>-</li>-<li>-<p>septic embolism</p>-<ul><li><p>usually from <a href="/articles/infective-endocarditis">infective endocarditis</a> <sup>3,8</sup></p></li></ul>-</li>-</ul>-</li>-<li><p>intracranial infection (e.g. <a href="/articles/cerebral-malaria-2">cerebral malaria</a>, <a href="/articles/intracranial-mycotic-aneurysm">mycotic aneurysm</a>) <sup>8</sup></p></li>-<li><p><a href="/articles/intravascular-lymphoma">intravascular lymphoma</a> <sup>8,17</sup></p></li>-<li><p><a href="/articles/linear-scleroderma" title="Linear scleroderma">linear scleroderma</a> <sup>25</sup></p></li>-<li><p><a href="/articles/moyamoya-disease-1">moyamoya disease</a> and <a href="/articles/moyamoya-syndrome-1">moyamoya syndrome</a> <sup>22,23</sup></p></li>-<li><p><a href="/articles/neurosarcoidosis">neurosarcoidosis</a> <sup>12,13</sup></p></li>-<li><p><a href="/articles/pontine-autosomal-dominant-microangiopathy-with-leukoencephalopathy-padmal" title="Pontine autosomal dominant microangiopathy with leukoencephalopathy (PADMAL)">pontine autosomal dominant microangiopathy with leukoencephalopathy (PADMAL)</a> <sup>27,28</sup></p></li>-<li><p><a href="/articles/posterior-reversible-encephalopathy-syndrome-1">posterior reversible encephalopathy syndrome (PRES)</a> <sup>8</sup></p></li>-<li><p><a href="/articles/parry-romberg-syndrome">progressive facial hemiatrophy (PFHA)</a> <sup>1,8</sup></p></li>-<li><p><a href="/articles/radiation-induced-cerebral-vasculopathy">radiation-induced cerebral vasculopathy</a> <sup>1,8</sup></p></li>-<li><p><a href="/articles/sneddon-syndrome">Sneddon syndrome</a> <sup>18,19</sup></p></li>-<li><p>thrombotic microangiopathies (e.g. <a href="/articles/haemolytic-uraemic-syndrome">haemolytic uraemic syndrome (HUS)</a> and <a href="/articles/thrombotic-thrombocytopenic-purpura">thrombotic thrombocytopenic purpura (TTP)</a>) <sup>8</sup></p></li>-</ul><h4>Radiographic features</h4><h5>MRI</h5><p>Cerebral microhaemorrhages are only seen on <a href="/articles/mri-2">MRI</a> and are only 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> <sup>24</sup>.</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> <sup>24</sup>. This blooming grossly overestimates the size of the lesions, thus they are usually inapparent on other MRI sequences and CT <sup>24</sup>.</p><h4>Differential diagnosis</h4><ul>-<li><p>artificial heart valve metallic emboli (very rare) <sup>8</sup></p></li>-<li><p><a href="/articles/flow-void">flow voids of veins</a> <sup>8</sup></p></li>-<li><p><a href="/articles/multiple-intracranial-calcifications">intracranial calcification</a> <sup>8</sup></p></li>-<li><p>punctate regions of signal loss in <a href="/articles/chronic-lymphocytic-inflammation-with-pontine-perivascular-enhancement-responsive-to-steroids-clippers" title="Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS)">chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS)</a> <sup>26</sup></p></li>-<li><p><a href="/articles/pneumocephalus">pneumocephalus</a> (very rare without preceding surgery) <sup>2</sup></p></li>- +<p><strong>Cerebral microhaemorrhages</strong>, or<strong> cerebral microbleeds</strong>,<strong> </strong>are small focal <a 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>
- +<li>
- +<p><a href="/articles/cerebral-cavernous-venous-malformation">cavernous malformations</a> <sup>1,8</sup></p>
- +<ul>
- +<li><p>especially <a href="/articles/zabramski-classification-of-cerebral-cavernous-malformations">Zabramski classification</a> type IV malformations</p></li>
- +<li><p>causes include <a href="/articles/familial-multiple-cavernous-malformation-syndrome">multiple (familial) cavernous malformation syndrome</a> and post-cerebral radiotherapy</p></li>
- +</ul>
- +</li>
- +<li>
- +<p><a href="/articles/cerebral-amyloid-angiopathy-1">cerebral amyloid angiopathy</a><sup> 1,8</sup></p>
- +<ul><li><p>typically involves the <a href="/articles/grey-white-differentiation">grey-white matter junction</a>; usually spares the <a href="/articles/basal-ganglia">basal ganglia</a></p></li></ul>
- +</li>
- +<li>
- +<p><a href="/articles/hypertensive-microangiopathy">chronic hypertensive encephalopathy</a> <sup>1,8</sup></p>
- +<ul><li><p>typically involve the basal ganglia, thalami, brainstem, cerebellum and <a href="/articles/corona-radiata">corona radiata</a></p></li></ul>
- +</li>
- +<li>
- +<p><a href="/articles/diffuse-axonal-injury">diffuse axonal injury (DAI)</a> and other trauma <sup>1,8</sup></p>
- +<ul><li><p>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 </p></li></ul>
- +</li>
- +</ul><h5>Less common aetiologies</h5><ul>
- +<li><p><a href="/articles/acute-haemorrhagic-leukoencephalitis">acute haemorrhagic leukoencephalitis (AHLE)</a> <sup>8</sup></p></li>
- +<li><p><a href="/articles/amyloid-related-imaging-abnormalities-aria">amyloid related imaging abnormalities (ARIA-H)</a> <sup>16</sup></p></li>
- +<li><p><a href="/articles/cathepsin-a-related-arteriopathy-with-strokes-and-leukoencephalopathy-carasal-1">cathepsin A-related arteriopathy with strokes and leukoencephalopathy (CARASAL)</a> <sup>29,30</sup></p></li>
- +<li>
- +<p><a href="/articles/cerebral-autosomal-dominant-arteriopathy-with-subcortical-infarcts-and-leukoencephalopathy-cadasil-1" title="Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)">cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)</a> <sup>1,8</sup></p>
- +<ul><li><p>microhaemorrhages have been reported to occur in 25–70% of cases without a characteristic distribution</p></li></ul>
- +</li>
- +<li><p><a href="/articles/cerebral-autosomal-recessive-arteriopathy-with-subcortical-infarcts-and-leukoencephalopathy-carasil" title="Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL)">cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL)</a> <sup>20,21</sup></p></li>
- +<li><p>cardiac bypass for surgery <sup>15,31</sup></p></li>
- +<li><p><a href="/articles/cerebral-hyperperfusion-syndrome">cerebral hyperperfusion syndrome</a> <sup>11</sup></p></li>
- +<li>
- +<p><a href="/articles/cerebral-vasculitis">cerebral vasculitis</a> (primary or secondary) <sup>1,8</sup></p>
- +<ul><li><p>microhaemorrhages usually located at the corticomedullary junction</p></li></ul>
- +</li>
- +<li>
- +<p><a href="/articles/col4a1-brain-small-vessel-disease">COL4A1 brain small-vessel disease</a> <sup>5,8</sup></p>
- +<ul><li><p>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 <a href="/articles/brainstem">brainstem</a> <sup>5,8</sup></p></li></ul>
- +</li>
- +<li>
- +<p><a href="/articles/haemorrhagic-micrometastases">haemorrhagic micrometastases</a> <sup>1,8</sup></p>
- +<ul><li><p>especially <a href="/articles/malignant-melanoma">melanoma</a> or <a href="/articles/renal-cell-carcinoma-1">renal cell carcinoma</a></p></li></ul>
- +</li>
- +<li><p>hypoxia and/or being critically ill (e.g. <a href="/articles/acute-respiratory-distress-syndrome-1">acute respiratory distress syndrome</a>, high-altitude exposure, <a href="/articles/covid-19-4">COVID-19</a>) <sup>8-10</sup></p></li>
- +<li><p><a href="/articles/immune-effector-cell-associated-neurotoxicity-syndrome-icans" title="Immune effector cell-associated neurotoxicity syndrome (ICANS)">immune effector cell-associated neurotoxicity syndrome (ICANS)</a> <sup>32</sup></p></li>
- +<li>
- +<p>intracranial embolism</p>
- +<ul>
- +<li>
- +<p><a href="/articles/cerebral-fat-embolism">fat embolism</a></p>
- +<ul><li><p>usually from fractures <sup>4,8,14</sup></p></li></ul>
- +</li>
- +<li>
- +<p>gas embolism <sup>6,7</sup></p>
- +<ul><li><p>many causes including: intravenous catheter placement, <a href="/articles/decompression-sickness">decompression sickness</a>, <a href="/articles/extracorporeal-membrane-oxygenation">extracorporeal membrane oxygenation</a>, <a href="/articles/hydrogen-peroxide">hydrogen peroxide ingestion</a>, etc.</p></li></ul>
- +</li>
- +<li>
- +<p>septic embolism</p>
- +<ul><li><p>usually from <a href="/articles/infective-endocarditis">infective endocarditis</a> <sup>3,8</sup></p></li></ul>
- +</li>
- +</ul>
- +</li>
- +<li><p>intracranial infection (e.g. <a href="/articles/cerebral-malaria-2">cerebral malaria</a>, <a href="/articles/intracranial-mycotic-aneurysm">mycotic aneurysm</a>) <sup>8</sup></p></li>
- +<li><p><a href="/articles/intravascular-lymphoma">intravascular lymphoma</a> <sup>8,17</sup></p></li>
- +<li><p><a href="/articles/linear-scleroderma" title="Linear scleroderma">linear scleroderma</a> <sup>25</sup></p></li>
- +<li><p><a href="/articles/moyamoya-disease-1">moyamoya disease</a> and <a href="/articles/moyamoya-syndrome-1">moyamoya syndrome</a> <sup>22,23</sup></p></li>
- +<li><p><a href="/articles/neurosarcoidosis">neurosarcoidosis</a> <sup>12,13</sup></p></li>
- +<li><p><a href="/articles/pontine-autosomal-dominant-microangiopathy-with-leukoencephalopathy-padmal" title="Pontine autosomal dominant microangiopathy with leukoencephalopathy (PADMAL)">pontine autosomal dominant microangiopathy with leukoencephalopathy (PADMAL)</a> <sup>27,28</sup></p></li>
- +<li><p><a href="/articles/posterior-reversible-encephalopathy-syndrome-1">posterior reversible encephalopathy syndrome (PRES)</a> <sup>8</sup></p></li>
- +<li><p><a href="/articles/parry-romberg-syndrome">progressive facial hemiatrophy (PFHA)</a> <sup>1,8</sup></p></li>
- +<li><p><a href="/articles/radiation-induced-cerebral-vasculopathy">radiation-induced cerebral vasculopathy</a> <sup>1,8</sup></p></li>
- +<li><p><a href="/articles/retinal-vasculopathy-with-cerebral-leukoencephalopathy-and-systemic-manifestations" title="Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S)">retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S)</a> <sup>33,34</sup></p></li>
- +<li><p><a href="/articles/sneddon-syndrome">Sneddon syndrome</a> <sup>18,19</sup></p></li>
- +<li><p>thrombotic microangiopathies (e.g. <a href="/articles/haemolytic-uraemic-syndrome">haemolytic uraemic syndrome (HUS)</a> and <a href="/articles/thrombotic-thrombocytopenic-purpura">thrombotic thrombocytopenic purpura (TTP)</a>) <sup>8</sup></p></li>
- +</ul><h4>Radiographic features</h4><h5>MRI</h5><p>Cerebral microhaemorrhages are only seen on <a href="/articles/mri-2">MRI</a> and are only 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> <sup>24</sup>.</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> <sup>24</sup>. This blooming grossly overestimates the size of the lesions, thus they are usually inapparent on other MRI sequences and CT <sup>24</sup>.</p><h4>Differential diagnosis</h4><ul>
- +<li><p>artificial heart valve metallic emboli (very rare) <sup>8</sup></p></li>
- +<li><p><a href="/articles/flow-void">flow voids of veins</a> <sup>8</sup></p></li>
- +<li><p><a href="/articles/multiple-intracranial-calcifications">intracranial calcification</a> <sup>8</sup></p></li>
- +<li><p>punctate regions of signal loss in <a href="/articles/chronic-lymphocytic-inflammation-with-pontine-perivascular-enhancement-responsive-to-steroids-clippers" title="Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS)">chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS)</a> <sup>26</sup></p></li>
- +<li><p><a href="/articles/pneumocephalus">pneumocephalus</a> (very rare without preceding surgery) <sup>2</sup></p></li>
References changed:
- 33. Wilms A, de Boer I, Terwindt G. Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic Manifestations (RVCL-S): An Update on Basic Science and Clinical Perspectives. Cereb Circ Cogn Behav. 2022;3:100046. <a href="https://doi.org/10.1016/j.cccb.2022.100046">doi:10.1016/j.cccb.2022.100046</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/36324396">Pubmed</a>
- 34. Yan Y, Jiang S, Wang R, Wang X, Li P, Wu B. Serial Magnetic Resonance Imaging Changes of Pseudotumor Lesions in Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic Manifestations: A Case Report. BMC Neurol. 2021;21(1):219. <a href="https://doi.org/10.1186/s12883-021-02250-4">doi:10.1186/s12883-021-02250-4</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/34107918">Pubmed</a>
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Image 19 MRI (Gradient Echo) ( create )
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Case 15: RVCL-S
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