Cerebral microhemorrhage

Hypertensive microangiopathy • Hypertensive encephalopathy and hypertrophic olivary degeneration - Ganzer Fall bei Radiopaedia

Hypertensive

microangiopathy • Hypertensive encephalopathy and hypertrophic olivary degeneration - Ganzer Fall bei Radiopaedia

Gaillard, F. Hypertensive encephalopathy and hypertrophic olivary degeneration. Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-49190 • CC by-nc-sa 3.0 (modified)

Comparison of conventional gradient echo T2*-weighted image (left, TE=20ms), susceptibility weighted image (SWI) and SWI phase image (center and right, respectively, TE=40ms) at 1.5 Tesla. Low signal foci in cerebral amyloid angiopathy (CAA) is shown.

Comparison of

conventional gradient echo T2*-weighted image (left, TE=20ms), susceptibility weighted image (SWI) and SWI phase image (center and right, respectively, TE=40ms) at 1.5 Tesla. Low signal foci in cerebral amyloid angiopathy (CAA) is shown.

Wikipedia • CC BY-SA 3.0

Cerebral microhemorrhage • Multiple cavernoma syndrome - Ganzer Fall bei Radiopaedia

Cerebral

microhemorrhage • Multiple cavernoma syndrome - Ganzer Fall bei Radiopaedia

Hospital, R. Multiple cavernoma syndrome. Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-13743 • CC by-nc-sa 3.0 (modified)

Cerebral microhemorrhage • Immune effector cell-associated neurotoxicity syndrome (ICANS) - Ganzer Fall bei Radiopaedia

Cerebral

microhemorrhage • Immune effector cell-associated neurotoxicity syndrome (ICANS) - Ganzer Fall bei Radiopaedia

Gaillard F, Immune effector cell-associated neurotoxicity syndrome (ICANS). Case study, Radiopaedia.org (Accessed on 30 Oct 2023) https://doi.org/10.53347/rID-163107 • CC by-nc-sa 3.0 (modified)

Cerebral microhemorrhage • Lymphoma - intravascular - Ganzer Fall bei Radiopaedia

Cerebral

microhemorrhage • Lymphoma - intravascular - Ganzer Fall bei Radiopaedia

Gewolb D, Lymphoma - intravascular. Case study, Radiopaedia.org (Accessed on 30 Oct 2023) https://doi.org/10.53347/rID-161419 • CC by-nc-sa 3.0 (modified)

Zahlreiche zerebrale Mikroblutungen vorwiegend Thalamus und Basalganglien am ehesten als folge einer zerebrale hypertensiven Angiopathie. Oben T2, T1, unten FLAIR, SWI. Die Befunde sind mit Abstand am besten in der suszeptibilitätsgewichteten Sequenz sichtbar.

Zahlreiche

zerebrale Mikroblutungen vorwiegend Thalamus und Basalganglien am ehesten als folge einer zerebrale hypertensiven Angiopathie. Oben T2, T1, unten FLAIR, SWI. Die Befunde sind mit Abstand am besten in der suszeptibilitätsgewichteten Sequenz sichtbar.

Wikipedia • CC BY-SA 4.0

Susceptibility weighted image (SWI) of diffuse axonal injury in trauma at 1.5 Tesla. Conventional GRE (left) with TE=20 ms and SWI (right) with TE=20 ms.

Susceptibility

weighted image (SWI) of diffuse axonal injury in trauma at 1.5 Tesla. Conventional GRE (left) with TE=20 ms and SWI (right) with TE=20 ms.

Wikipedia • CC BY-SA 3.0

Microbleeds show a characteristic distribution in cerebral fat embolism. A case showing microhemorrhages as seen on CT. Axial native CT scan images at the level of the centrum semiovale and the basal ganglia of a 16-year-old polytraumatised female patient acquired on postoperative day 11 after hospital admission. Multiple subcortical punctiform hyperdensities presumably representing microhemorrhages are seen bilaterally in the subcortical white matter (a), and a larger hyperdensity is seen in the genu of the corpus callosum (b)

Microbleeds

show a characteristic distribution in cerebral fat embolism. A case showing microhemorrhages as seen on CT. Axial native CT scan images at the level of the centrum semiovale and the basal ganglia of a 16-year-old polytraumatised female patient acquired on postoperative day 11 after hospital admission. Multiple subcortical punctiform hyperdensities presumably representing microhemorrhages are seen bilaterally in the subcortical white matter (a), and a larger hyperdensity is seen in the genu of the corpus callosum (b)

insightsimaging.springeropen.com • CC-by-4.0

Microbleeds show a characteristic distribution in cerebral fat embolism. A case representing the walnut kernel microbleed pattern. SWI (a–d) MRI images at the level of the centrum semiovale (a), at the level of the corona radiata (b), at the level of the basal ganglia (c), and at the level of the brainstem and the cerebellum (d) of a 16-year-old polytraumatised female patient acquired on day 12 after hospital admission. SWI shows very high number of monotonous punctuate microbleeds in the subcortical white matter, the internal capsule, the corpus callosum, the cerebellum and the brainstem resembling a “walnut kernel”. The larger hypointensity visible in the right centrum semiovale and near the third ventricle is due to a ventricular drain (a–c)

Microbleeds

show a characteristic distribution in cerebral fat embolism. A case representing the walnut kernel microbleed pattern. SWI (a–d) MRI images at the level of the centrum semiovale (a), at the level of the corona radiata (b), at the level of the basal ganglia (c), and at the level of the brainstem and the cerebellum (d) of a 16-year-old polytraumatised female patient acquired on day 12 after hospital admission. SWI shows very high number of monotonous punctuate microbleeds in the subcortical white matter, the internal capsule, the corpus callosum, the cerebellum and the brainstem resembling a “walnut kernel”. The larger hypointensity visible in the right centrum semiovale and near the third ventricle is due to a ventricular drain (a–c)

insightsimaging.springeropen.com • CC-by-4.0

Cerebral microhemorrhage • Cerebral amyloid angiopathy - Ganzer Fall bei Radiopaedia

Cerebral

microhemorrhage • Cerebral amyloid angiopathy - Ganzer Fall bei Radiopaedia

Gaillard, F. Cerebral amyloid angiopathy. Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-46082 • CC by-nc-sa 3.0 (modified)

Cerebral microhemorrhage • Radiotherapy induced microhemorrhages - Ganzer Fall bei Radiopaedia

Cerebral

microhemorrhage • Radiotherapy induced microhemorrhages - Ganzer Fall bei Radiopaedia

Gaillard, F. Radiotherapy induced microhemorrhages. Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-46171 • CC by-nc-sa 3.0 (modified)

Cerebral microhemorrhage • Parry-Romberg syndrome with intracranial manifestations - Ganzer Fall bei Radiopaedia

Cerebral

microhemorrhage • Parry-Romberg syndrome with intracranial manifestations - Ganzer Fall bei Radiopaedia

Saad, A. Parry-Romberg syndrome with intracranial manifestations. Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-50949 • CC by-nc-sa 3.0 (modified)

Cerebral microhemorrhage • Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) - Ganzer Fall bei Radiopaedia

Cerebral

microhemorrhage • Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) - Ganzer Fall bei Radiopaedia

Hanh, L. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-95083 • CC by-nc-sa 3.0 (modified)

Diffuses axonales Schertrauma bei Motorradunfall. Kontrolle in der MRT nach 3 Tagen: Man erkennt die aus der CCT bekannte kleine balkennahe Blutung in der T1w schon nicht mehr. Gut zu sehen allerdings in FLAIR, DWI und am besten in der T2* (Haem).

Diffuses

axonales Schertrauma bei Motorradunfall. Kontrolle in der MRT nach 3 Tagen: Man erkennt die aus der CCT bekannte kleine balkennahe Blutung in der T1w schon nicht mehr. Gut zu sehen allerdings in FLAIR, DWI und am besten in der T2* (Haem).

Wikipedia • CC BY-SA 3.0

Cerebral microhemorrhage • COVID-19 complicated by leukoencephalopathy and cerebral microhemorrhages - Ganzer Fall bei Radiopaedia

Cerebral

microhemorrhage • COVID-19 complicated by leukoencephalopathy and cerebral microhemorrhages - Ganzer Fall bei Radiopaedia

Elswood, T. COVID-19 complicated by leukoencephalopathy and cerebral microhemorrhages. Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-94888 • CC by-nc-sa 3.0 (modified)

Cerebral microhemorrhage • Posterior reversible encephalopathy syndrome with microhemorrhage (importance of susceptibility-weighted imaging) - Ganzer Fall bei Radiopaedia

Cerebral

microhemorrhage • Posterior reversible encephalopathy syndrome with microhemorrhage (importance of susceptibility-weighted imaging) - Ganzer Fall bei Radiopaedia

Ibrahim, D. Posterior reversible encephalopathy syndrome with microhemorrhage (importance of susceptibility-weighted imaging). Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-87081 • CC by-nc-sa 3.0 (modified)

Cerebral microhemorrhage • Amyloid-related imaging abnormalities (ARIA) - Ganzer Fall bei Radiopaedia

Cerebral

microhemorrhage • Amyloid-related imaging abnormalities (ARIA) - Ganzer Fall bei Radiopaedia

Duarte, R. Amyloid-related imaging abnormalities (ARIA). Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-147243 • CC by-nc-sa 3.0 (modified)

Hypertensive microangiopathy • Chronic hypertensive encephalopathy - Ganzer Fall bei Radiopaedia

Hypertensive

microangiopathy • Chronic hypertensive encephalopathy - Ganzer Fall bei Radiopaedia

Gaillard, F. Chronic hypertensive encephalopathy. Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-4564 • CC by-nc-sa 3.0 (modified)

Hypertensive microangiopathy • Chronic hypertensive encephalopathy - Ganzer Fall bei Radiopaedia

Hypertensive

microangiopathy • Chronic hypertensive encephalopathy - Ganzer Fall bei Radiopaedia

Gaillard, F. Chronic hypertensive encephalopathy. Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-25764 • CC by-nc-sa 3.0 (modified)

Hypertensive microangiopathy • Chronic hypertensive encephalopathy - Ganzer Fall bei Radiopaedia

Hypertensive

microangiopathy • Chronic hypertensive encephalopathy - Ganzer Fall bei Radiopaedia

Gaillard, F. Chronic hypertensive encephalopathy. Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-72844 • CC by-nc-sa 3.0 (modified)

Central nervous system vasculitis • Granulomatous vasculitis - Ganzer Fall bei Radiopaedia

Central

nervous system vasculitis • Granulomatous vasculitis - Ganzer Fall bei Radiopaedia

S R, Granulomatous vasculitis. Case study, Radiopaedia.org (Accessed on 08 Dec 2022) https://doi.org/10.53347/rID-98233 • CC by-nc-sa 3.0 (modified)

Radiopaedia • CC-by-nc-sa 3.0 • de

siehe auch

Zerebrale Amyloidangiopathie
Pneumocephalus
Diffuses axonales Schädelhirntrauma
zerebrale Kavernome
Kavernom
CADASIL
zerebrale Mikroangiopathie bei Hypertonus
Mikroblutungen
Taucherkrankheit
Mikroblutungen in den Basalganglien
Mikroblutungen im Thalamus
multiple (familial) cavernous malformation syndrome
Vaskulitis des Zentralen Nervensystems

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

Pathology

Common etiologies

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

Less common etiologies

acute hemorrhagic leukoencephalitis (AHLE)
CADASIL
- microhemorrhages have been reported to occur in 25–70% of cases without a characteristic distribution
cerebral hyperperfusion syndrome
cerebral vasculitis (primary or secondary)
- microhemorrhages usually located at the corticomedullary junction
COL4A1 brain small-vessel disease
- microhemorrhages have been reported in up to 53% of cases, characteristically in the centrum semiovale, deep gray matter, or brainstem
hemorrhagic micrometastases
- especially melanoma or renal cell carcinoma
hypoxia (e.g. acute respiratory distress syndrome, high-altitude exposure, being critically ill)
intracranial embolism:
- fat embolism
  - usually from fractures
- gas embolism
  - many causes including: intravenous catheter placement, decompression sickness, extracorporeal membrane oxygenation, hydrogen peroxide ingestion, etc.
- septic embolism
  - usually from infective endocarditis
intracranial infection (e.g. cerebral malaria, mycotic aneurysm)
intravascular lymphoma
posterior reversible encephalopathy syndrome (PRES)
progressive facial hemiatrophy (PFHA)
radiation-induced cerebral vasculopathy
thrombotic microangiopathies (e.g. hemolytic uremic syndrome and thrombotic thrombocytopenic purpura)

Radiographic features

Cerebral microhemorrhages are generally 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 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.