hemosiderin deposition in brain symptoms

The literature is divided as to whether the term superficial siderosis should be confined to cases where there is no history of symptomatic subarachnoid hemorrhage, or whether it is a blanket term referring to the superficial deposition of hemosiderin, irrespective of cause. Before These data are of clinical relevance, suggesting that basal ganglia MRI microbleeds may be a surrogate for ischaemic small vessel disease rather than exclusively a haemorrhagic diathesis. 22 Rivkin et al 40 measured T2* values in brain tissue . 10.1038/nm840. You quickly wipe it off, stop the spreading. AVM Accounts for 1.5-4% of all brain masses; most supratentorial Admixture of arteries, veins, and intermediate- sized vessels Vessels are separated by gliotic neural parenchyma Foci of mineralization and hemosiderin deposi- tion are common Typically superficial, wedge-shaped, with the apex directed toward the ventricle Commonly found in . Because CAA is present in up to 90% of AD cases [52], it may be conceptually feasible to state that lobar MBs are reliable markers of CAA in patients with AD. 8. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Neurology. Depending on the amount of iron that remains in the lungs people may have no problems or varying degrees of lung damage. Not all patients have an identifiable source of hemorrhage. J. Neurosurg. In these studies, two main forms of vasculopathies have been associated with MBs in the aging brain: CAA and hypertensive vasculopathy (HV). Neurology. Patients tend to also exhibit other manifestations of hemochromatosis . Molecular markers of gliosis and tissue integrity were assessed by immunohistochemistry in brains with highest (n = 20) and lowest (n = 20) levels of putamen haemosiderin. 2004, 25: 714-719. 10.1148/radiol.2481071158. Neurology. One of these studies found that the presence of at least one MB yielded a more than twofold increase, but not a significant risk of non-AD dementia [57]. 10.1212/01.wnl.0000307750.41970.d9. 2022 Mar 8;10:e13101. 10.1002/ana.22099. 7. 10.1159/000139661. J Alzheimers Dis. Poels MM, Ikram MA, van der Lugt A, Hofman A, Niessen WJ, Krestin GP, Breteler MM, Vernooij MW: Cerebral microbleeds are associated with worse cognitive function: the Rotterdam Scan Study. After this initial study, reports of MBs in ICH and other populations have dramatically increased. Hemosiderin deposition was found to be increasingly widespread in these patients; however, the specific regions affected varied from case to case. 2010;113 (1): 97-101. Cookies policy. Taken together, these observations strongly support MBs as an additional marker of SVD. Stroke. 2012, 79: 320-326. As such, MBs are regularly identified in individuals from stroke and memory clinics, where they might have implications in therapeutic management. Cheng AL, Batool S, McCreary CR, Lauzon ML, Frayne R, Goyal M, Smith EE: Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds. Stroke. CAS The association between haemosiderin counts and degenerative and vascular brain pathology, clinical data, and the haemochromatosis (HFE) gene H63D genotype were analysed. 2013, 73: 439-441. The site is secure. There still exists another line of investigation providing support to the link between lobar MB and CAA, and it consists of the study of CAA patients with both MRI and Pittsburgh compound B (PiB)-positron emission tomography (PET) imaging. There are two types of SS. Before Acta Neuropathol. Prevalence of Superficial Siderosis in Patients with Cerebral Amyloid Angiopathy. 9. Microbleed and microinfarct detection in amyloid angiopathy: a high-resolution MRI-histopathology study. 10.1093/brain/awq321. When the ketchup first lands, it is clearly visible, has three dimensional mass and continues to spread. These tumors are often associated with intralesional hemorrhage and hemosiderin deposition; because hemosiderin includes paramagnetic Fe+3 atoms, . Alz Res Therapy 6, 33 (2014). However, it is important to note that only a small proportion of AD cases (23%) actually exhibit lobar MBs [51]. Enter search terms to find related medical topics, multimedia and more. Hold deg oppdatert om ny forskning og medisinske nyheter. . 34 Hemosiderin deposition (which included hemorrhagic lacunes and microhemorrhages) was more predominant among ischemic stroke Adv Exp Med Biol. MBs were predictive not only of executive dysfunction but also of memory, language, and visuospatial impairment. 10.1212/WNL.0b013e3181eee40f. Gregoire SM, Brown MM, Kallis C, Jager HR, Yousry TA, Werring DJ: MRI detection of new microbleeds in patients with ischemic stroke: five-year cohort follow-up study. One of the initial studies assessing the cognitive impact of MBs compared the performance on multiple cognitive domains between patients with and without MBs from a neurovascular clinic [44]. Nakata Y, Shiga K, Yoshikawa K, Mizuno T, Mori S, Yamada K, Nakajima K: Subclinical brain hemorrhages in Alzheimers disease: evaluation by magnetic resonance T2*-weighted images. Neuropathology and Applied Neurobiology published by John Wiley & Sons Ltd on behalf of British Neuropathological Society. Google Scholar. Epub 2011 Aug 7. A cause of recurrent subarachnoid hemorrhage is present in ~50% of cases 1-6,8: Usually unrewarding; will not demonstrate a point of bleeding 1. In some cases, it may develop in other areas of the body, such as the inside of the elbow, after intravenous iron injections. His symptoms worsened with time and he developed lower limb weakness and shortness of breath. In logistic regression analyses, the presence of MBs was the only independent predictor of executive dysfunction. This observation raises questions about the pathological significance of MBs and the importance of MB detection in asymptomatic individuals. Careers. 10.1161/STROKEAHA.110.607184. The https:// ensures that you are connecting to the PubMedGoogle Scholar. Dement Geriatr Cogn Disord. Nakata-Kudo Y, Mizuno T, Yamada K, Shiga K, Yoshikawa K, Mori S, Nishimura T, Nakajima K, Nakagawa M: Microbleeds in Alzheimer disease are more related to cerebral amyloid angiopathy than cerebrovascular disease. Brain. 10.1161/STROKEAHA.109.558197. Still, consensus guidelines on MB detection and interpretation have been published [9]. & Viswanathan, A. Cerebral microbleeds: overview and implications in cognitive impairment. Rinsho Shinkeigaku. Stroke. Two early studies failed to demonstrate any influence of MBs on cognitive performance in AD cohorts [47, 49]. Aetiologically a haemorrhage (acute or chronic) is present in the subarachnoid space. The clinical signs of iron toxicity in children are retarded growth, splenomegaly, cardiomyopathy, and endocrinopathies. Bethesda, MD 20894, Web Policies van der Vlies AE, Goos JD, Barkhof F, Scheltens P, van der Flier WM: Microbleeds do not affect rate of cognitive decline in Alzheimer disease. In this case, low MB counts may have prevented this study from identifying associations. PubMed Central If you do not see the PDF file or want to save the file, you can right-click on the PDF icon. 1. (2001) ISBN: 0781725682 -, 6. Cianchetti FA, Kim DH, Dimiduk S, Nishimura N, Schaffer CB: Stimulus-evoked calcium transients in somatosensory cortex are temporarily inhibited by a nearby microhemorrhage. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. 10.1161/STROKEAHA.113.002267. Overall, there is a male predilection (M:F 3:1) 2,5. Direct pathological observations have demonstrated the existence of tissue damage surrounding MBs [7, 1517]. Pain and fatigue in the legs Swelling, especially after long periods of sitting or standing still Cramps Varicose veins Itching or flaking skin Sores that don't heal Chronic venous insufficiency is. Neurology. 2006 Jan 24;66(2):165-71. doi: 10.1212/01.wnl.0000194266.55694.1e. 10.1161/STROKEAHA.111.647271. Stroke. Associations and implications of cerebral microbleeds. MBs were first reported in association with intracerebral hemorrhage (ICH) [11]. Also, the topographic distribution of these MBs has been shown to be potentially associated with specific underlying vasculopathies. Programs & Resources Beta-amyloid, total tau and phospho-tau in cerebrospinal fluid were consistent with Alzheimer's disease. Google Scholar. doi: 10.7717/peerj.13101. J Magn Reson Imaging. Kikuta K, Takagi Y, Nozaki K, Okada T, Hashimoto N: Histological analysis of microbleed after surgical resection in a patient with moyamoya disease. For the cortical type, (transient) focal neurological symptoms are found, but also development of dementia (1). Offenbacher H, Fazekas F, Schmidt R, Koch M, Fazekas G, Kapeller P: MR of cerebral abnormalities concomitant with primary intracerebral hematomas. Tidsskrift for Den norske legeforening, Postboks 1152 Sentrum, 0107 OSLO, Sentralbord: 23 10 90 00 Email: redaksjonen@tidsskriftet.no. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Stroke. The frequency of MRI CMB in 10 cases with highest and lowest burden of putamen haemosiderin, was compared using post mortem 3T MRI. Knudsen KA, Rosand J, Karluk D, Greenberg SM: Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. The Whole Picture: From Isolated to Global MRI Measures of Neurovascular and Neurodegenerative Disease. Linn J, Halpin A, Demaerel P et al. 10.1212/01.WNL.0000148604.77591.67. -. Privacy Four years before his hospitalisation, a man in his 90s had a left-sided intraparenchymal cerebral haemorrhage parietally with penetration into the subarachnoid space. 10.1161/STROKEAHA.106.477315. Hemosiderosis caused by bleeding and red blood cell breakdown does not usually require treatment. 1999, 20: 637-642. This article will provide an overview of the signs, symptoms, causes, risk factors, diagnosis, and treatment of superficial siderosis. ), The lungs and kidneys are often sites of hemosiderosis. Lee SH, Ryu WS, Roh JK: Cerebral microbleeds are a risk factor for warfarin-related intracerebral hemorrhage. There are several ways to explain this dissociation between the post-mortem pathological findings of CAA and MB detection during life. Magnetic resonance imaging (MRI) cerebral microbleeds (CMB) arise from ferromagnetic haemosiderin iron assumed to derive from extravasation of erythrocytes. At present, it is indirect evidence from population-based studies that mostly supports the associations between lobar/deep MBs and CAA/HV. Pettersen JA, Sathiyamoorthy G, Gao FQ, Szilagyi G, Nadkarni NK, St George-Hyslop P, Rogaeva E, Black SE: Microbleed topography, leukoaraiosis, and cognition in probable Alzheimer disease from the Sunnybrook dementia study. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 10.1007/s00401-009-0615-z. HHS Vulnerability Disclosure, Help On imaging, it is classically characterized on MRI as a rim of low signal coating the surface of the brain or spinal cord, particularly noted with the gradient echo or susceptibility-weighted sequences. Unable to load your collection due to an error, Unable to load your delegates due to an error. These phenomena provide a scientific basis to support direct clinical effects of MBs, beyond their associations with particular vasculopathies. 2003, 9: 112-122. Biffi A, Halpin A, Towfighi A, Gilson A, Busl K, Rost N, Smith EE, Greenberg MS, Rosand J, Viswanathan A: Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy. A unifying hypothesis for a patient with superficial siderosis, low-pressure headache, intraspinal cyst, back pain, and prominent vascularity. The ability of the brain to biosynthesize ferritin in response to prolonged contact with hemoglobin iron is important in the . 2022 Feb;53(2):404-415. doi: 10.1161/STROKEAHA.121.032608. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada)dedicated to using leading-edge science to save and improve lives around the world. 2017 Apr 1;140(4):1107-1116. doi: 10.1093/brain/awx003. Cite this article. AJNR Am J Neuroradiol. government site. 1995;118 ( Pt 4)(4):1051-66. Given these observations, it seems reasonable to individualize decisions on anti-thrombotic therapy in patients with MBs. Greenberg SM, Vernooij MW, Cordonnier C, Viswanathan A, Al-Shahi Salman R, Warach S, Launer LJ, Van Buchem MA, Breteler MM: Cerebral microbleeds: a guide to detection and interpretation. It is typically caused by disorders that affect blood flow, such as CVI. As there are many causes of recurrent or extensive subarachnoid hemorrhage, the demographics are ill-defined and represent those of the underlying cause. Superficial hemosiderosis of the 'classical type' is a rare but potentially serious condition resulting from leptomeningeal hemosiderin accumulation on the surface of the cerebellum, around the cranial nerves and spinal cord. Later, he underwent a computerized tomography chest scan. Brain. and transmitted securely. sharing sensitive information, make sure youre on a federal BMJ Case Rep. 2019 Jun 8;12(6):e230431. Nandigam RN, Viswanathan A, Delgado P, Skehan ME, Smith EE, Rosand J, Greenberg SM, Dickerson BC: MR imaging detection of cerebral microbleeds: effect of susceptibility-weighted imaging, section thickness, and field strength. Kumar N, Cohen-Gadol AA, Wright RA, Miller GM, Piepgras DG, Ahlskog JE. 1991, 30: 637-649. Google Scholar. HHS Vulnerability Disclosure, Help Disclaimer. Kumar N, Miller GM, Piepgras DG et-al. Neuroimaging Clin N Am. FOIA Prognostically a slow progression is usually observed for cerebral hemosiderosis, but a rapid deterioration with a fatal outcome has also been described (2). 2010;41:S103106. Hemosiderin or haemosiderin is an iron-storage complex that is composed of partially digested ferritin and lysosomes.The breakdown of heme gives rise to biliverdin and iron. Poels MM, Ikram MA, van der Lugt A, Hofman A, Krestin GP, Breteler MM, Vernooij MW: Incidence of cerebral microbleeds in the general population: the Rotterdam Scan Study. Motta vrt nyhetsbrev! In the case of the cortical type, hemosiderosis is located supratentorially (above the cerebral convexity), and a cerebral amyloid angiopathy is regarded as an aetiological key factor, particularly in older patients. 2008, 248: 272-277. For instance, 7-Tesla MRI detects twice as many MBs in comparison to conventional 1.5-Tesla MRI [7]. Disorders that cause inflammation that lasts for an extended period, such as nonalcoholic fatty liver disease Fatty Liver Fatty liver is an abnormal accumulation of certain fats (triglycerides) inside liver cells. If people have a disorder that causes excessive breakdown of red blood cells within the blood vessels (for example, hemolytic anemia Aplastic Anemia Aplastic anemia is a disorder in which the cells of the bone marrow that develop into mature blood cells are damaged, leading to low numbers of red blood cells, white blood cells, and/or platelets read more ), iron released from the red blood cells can accumulate within the kidneys (renal hemosiderosis). 2008, 70: 1208-1214. Vestibulocochlear nerve (CN VIII) dysfunction resulting in a sensorineural hearing loss is believed to be due to the combination of a long cisternal course (thus with ample exposure to the subarachnoid space) and the susceptibility of microglial cells (which have a role in myelination) to be damaged by iron compounds 4. 2011, 42: 656-661. A later study on the same cohort reported that MBs were not associated with a faster rate of cognitive decline, suggesting that the increase in mortality may be related to other clinical events, like ICH [59]. 2004, 127: 2265-2275. 2019;1205:25-53. doi: 10.1007/978-3-030-31904-5_3. Several underlying conditions lead to the development of SS. Neurology. By using this website, you agree to our Abnormal iron deposition can be injurious to the brain and brain systems, as iron is a transitional metal and participates in redox reactions to form reactive oxygen species (ROS) that, in turn, can cause oxidative stress [ 16 ]. Manage cookies/Do not sell my data we use in the preference centre. Neurology. Chichester, West Sussex: John Wiley & Sons, 2014: 396-459. Akoudad S, de Groot M, Koudstaal PJ, van der Lugt A, Niessen WJ, Hofman A, Ikram MA, Vernooij MW: Cerebral microbleeds are related to loss of white matter structural integrity. In long-standing cases, cerebellar atrophy may also be present. Neurol Med Chir. official website and that any information you provide is encrypted 2010, 41: 184-186. Prevalence and risk factors of cerebral microbleeds: an update of the Rotterdam scan study. 10.1212/WNL.0b013e3182661f91. Neuroimaging-pathological correlation studies are needed to confirm these associations. 2011, 42: 638-644. The downsides of these technical improvements are the increase in the blooming effect (larger visual appearance of MBs on MRI than the actual size of the hemosiderin deposit) [8] and the frequency of MB mimics, which raises concerns about potential overdetection of MBs and a limited clinical significance (especially if supporting pathological data are not available). Hemosiderin is a strong paramagnetic material, which allows its detection when a magnetic field is applied [ 1 ]. 10.1212/WNL.43.10.2073. Unauthorized use of these marks is strictly prohibited. Cognitive impairment (and dementia) represents an increasing source of severe long-term disability and will be the focus of the review in the next sections. CT of the head, thorax, abdomen and pelvis were normal. Lippincott Williams & Wilkins. superficial hemosiderosis due to myxopapillary ependymoma) 5. 10.1159/000088665. Cerebral microbleeds (MBs) are small chronic brain hemorrhages which are likely caused by structural abnormalities of the small vessels of the brain. 2009, 40: 3455-3460. Two studies investigated the value of MBs in predicting progression from mild cognitive impairment to dementia. Cerebrovasc Dis. Symptoms of compression neuropathy can be present if the lesion is in the vicinity of peripheral nerves (e.g., carpal tunnel or Guyon's canal). doi: 10.1136/bcr-2019-230431. 2022 Sep 2;23(17):10018. doi: 10.3390/ijms231710018. In a subsequent study based on the same population, lobar MBs were seen to occur significantly more often in the temporal lobe [23], one of the regions severely affected by CAA. Koennecke HC: Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. An early trial of active immunization reported some cases of severe meningoencephalitis, which prompted its termination [60]. The https:// ensures that you are connecting to the 2011, 42: 494-497. 2012, 78: 326-333. 2001, 56: 537-539. Grouped clusters of several profiles ( a ;, ( a ) Perspex chamber loaded with formalin fixed frontal lobe brain slices. Cerebral microbleeds in the elderly: a pathological analysis. Sjefredaktr Are Brean Tidsskriftet er et medisinskvitenskapelig tidsskrift med pen tilgang, indeksert i Pubmed, Google Scholar, Crossref, ESCI og DOAJ. AJNR Am J Neuroradiol. Hemosiderin staining can also occur after . -, Poels MM, Vernooij MW, Ikram MA, Hofman A, Krestin GP, van der Lugt A, Breteler MM. eCollection 2020. Nat Med. CAS On returning home, the patient developed symptoms of headache, nausea, and vomiting. Choi P, Ren M, Phan TG, Callisaya M, Ly JV, Beare R, Chong W, Srikanth V: Silent infarcts and cerebral microbleeds modify the associations of white matter lesions with gait and postural stability: population-based study. -, Koennecke HC. (A) Multiple lobar microbleeds distributed across the temporal lobes. Unable to load your collection due to an error, Unable to load your delegates due to an error, Box and whisker plots showing relationship between the density of haemosiderin deposition and both local (. MRC Cognitive Function and Ageing Neuropathology Study, See this image and copyright information in PMC. J Alzheimers Dis. Because of the differential topographic preference of CAA and HV, MBs associated with these two entities could be expected to follow similar distributions: strictly lobar (cortical-subcortical regions of brain lobes and cerebellum) in CAA; strictly deep (deep white matter, basal ganglia, thalamus, brainstem, cerebellum) in HV; and mixed (lobar and deep regions) when an individual has coexisting CAA and HV. HV, a consequence of long-standing hypertension over the microvasculature of the brain, is pathologically defined by the presence of lipofibrohyalinosis, which affects mostly the deep penetrating arterioles. Haemosiderin deposition and vascular pathology in the putamen were quantified in 200 brains donated to the population-representative Medical Research Council Cognitive Function and Ageing Study. Article Acta Neurochir (Wien). 2010;31(1):5-14. eCollection 2021. Finally, MBs may have some impact on current immunotherapies for AD. Superficial siderosisis a rare condition which results from the deposition of hemosiderin along the leptomeninges, with eventual neurological dysfunction. 10.1212/WNL.0b013e3182020349. 2005, 20: 412-414. 2003, 9: 448-452. At the time the article was last revised Yahya Baba had As stated, direct tissue damage or underlying SVD (or both) may account for these detrimental effects. Isolated spinal cord compression syndrome revealing delayed extensive superficial siderosis of the central nervous system secondary to cervical root avulsion. Springer Nature. The lungs and kidneys are often sites of hemosiderosis. 10.1161/STROKEAHA.108.531343. Careers. It also shows up in people who have inflammation in the layer of fat beneath the skin of the lower legs (lipodermatosclerosis). Cerebral microbleeds: a guide to detection and interpretation. 2010;41:27822785. 2008, 65: 790-795. In "classical"-type SS, hypointense MRI signals are observed in the brainstem and cerebellum with diffuse and symmetrical margins. Three cases of superficial siderosis of the central nervous system and review of the literature. Causes of Hemosiderin Staining. Cordonnier C, van der Flier WM, Sluimer JD, Leys D, Barkhof F, Scheltens P: Prevalence and severity of microbleeds in a memory clinic setting. (B) Isolated deep microbleed in the lateral aspect of the right thalamus. It is only found within cells (as opposed to circulating in . Chrostowski J, Majos M, Walczak A, Wachowski M, Majos A. Pol J Radiol. CAS Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. Please enable it to take advantage of the complete set of features! Over time, further sequences have been developed, including three-dimensional T2*-GRE [3] and the most sensitive one to date - susceptibility-weighted imaging (SWI) [4]. However, these associations were more robust in individuals with strictly lobar MBs (all analyses adjusted for age, sex, education, vascular risk factors, other SVD markers, and brain atrophy). MRI of the Brain II. For instance, calcifications, ferritin, and melanoma may appear identical to each other based solely on imaging [5 Takada]. In the other study, MBs detected on SWI sequences were found to predict cognitive decline in patients followed up to 5 years [58]. Although CNS involvement in hemochromatosis may be asymptomatic and incidentally noted radiographically, patients may present with: movement disorders (e.g. med., senior consultant. Whereas the AGES study confirmed in community-dwelling individuals the suggested link between deep MBs and subcortical cognitive deficits, the Rotterdam Scan Study emphasized the negative effects of lobar MBs on a wider spectrum of cognitive domains [43]. Banerjee G, Kim HJ, Fox Z, Jger HR, Wilson D, Charidimou A, Na HK, Na DL, Seo SW, Werring DJ. It is thus a hopeful treatment option for SS. Hemosiderin is also generated from the abnormal metabolic pathway of ferritin.. Philip J. Kistler Stroke Research Center, Massachusetts General Hospital, 175 Cambridge Street Suite 300, Boston, MA, 02114, USA, Sergi Martinez-Ramirez,Steven M Greenberg&Anand Viswanathan, You can also search for this author in Werring DJ, Frazer DW, Coward LJ, Losseff NA, Watt H, Cipolotti L, Brown MM, Jager HR: Cognitive dysfunction in patients with cerebral microbleeds on T2*-weighted gradient-echo MRI. Hemosiderosis can result from, Direct bleeding into the tissues that is followed by breakdown of red blood cells and release of iron to the tissues, Destruction of red blood cells within the blood vessels, leading to release of iron into the blood followed by accumulation of iron inside the kidneys as the kidneys filter waste from the blood. Deferiprone, which is a lipid-soluble iron chelator that can penetrate the blood-brain barrier, is reportedly effective at improving the clinical symptoms and deposition of hemosiderin. Neuroimaging studies have consistently reported associations between MB, vascular risk factors (age and hypertension) and previously well-established markers of small-vessel disease (SVD), such as lacunar infarcts and white matter hyperintensities (WMHs) [17]. Schrag M, McAuley G, Pomakian J, Jiffry A, Tung S, Mueller C, Vinters HV, Haacke EM, Holshouser B, Kido D, Kirsch WM: Correlation of hypointensities in susceptibility-weighted images to tissue histology in dementia patients with cerebral amyloid angiopathy: a postmortem MRI study. Check for errors and try again. 10.1161/STROKEAHA.110.596122. Neurology. PubMed Still, some data support the presence of MBs as an independent risk factor for warfarin-related ICH [32]. The amyloid cascade hypothesis [53], in combination with further theories on amyloid clearance through perivascular spaces [54], supports this notion. Unable to process the form. MBs were distributed mostly in the cortical areas, predominantly in the fronto-temporal lobes, and this might suggest a high prevalence of CAA in this cohort. 2010, 68: 545-548. Apart from offering hints on AD pathophysiology, their presence may modify the course of the disease and even the response to new immunotherapeutic agents. Geriatric neurology. AJNR Am J Neuroradiol. Fazekas F, Kleinert R, Roob G, Kleinert G, Kapeller P, Schmidt R, Hartung HP: Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. The cautious approach to anti-thrombotic therapy in patients with these symptomatic episodes can be extended to all patients exhibiting MBs. Ann Neurol. This argued against setting a strict limit for the maximum diameter of MBs; however, the study reported a value of 5.7 mm as the best cutoff to distinguish between the two types of hemorrhages [10]. Stains. G0800380/MRC_/Medical Research Council/United Kingdom, MC_U105292687/MRC_/Medical Research Council/United Kingdom, MR/L016451/1/MRC_/Medical Research Council/United Kingdom, G0900582/MRC_/Medical Research Council/United Kingdom, G1100540/MRC_/Medical Research Council/United Kingdom, G0900652/MRC_/Medical Research Council/United Kingdom, G9901400/MRC_/Medical Research Council/United Kingdom, G0400074/MRC_/Medical Research Council/United Kingdom, G0502157/MRC_/Medical Research Council/United Kingdom, Fazekas F, Kleinert R, Roob G, Kleinert G, Kapeller P, Schmidt R, Hartung HP.