CEREBRAL MICROBLEEDS AS A NEUROIMAGING BIOMARKER FOR BOTH DEMENTIA AND STROKE - REPORT OF A CASE
1 Department of Neurology, Far Eastern Memorial Hospital
Cerebral microbleeds (CMB) is defined as small perivascular hemosiderin deposits leaking from cerebral small vessels, which is typically an unexpected finding on Magnetic Resonance Imaging (MRI) of the brain. CMBs may cause dementia and stroke. Herein we present a 79-year-old man who was admitted due to acute left-sided weakness. He was a Lions Club president until 20 years ago, and afterwards he had a series of business failure. Moreover, he had gait disturbance with multiple falls during the past 10 years and has been ADL dependent after a second stroke one year ago. Neurological examination showed dementia (CASI: 26, CDR: 2), left-sided hemiparesis, and bedridden state. Diffusion-weighted MRI revealed acute right pontine infarction, and susceptibility-weighted imaging showing 159 microbleeds involving bilateral hemisphere, bilateral basal ganglia, bilateral thalami, bilateral cerebellum, and pons. Using Microbleed Anatomical Rating Scale (MARS), there were 112 microbleeds in the lobar regions, 12 in the infratentorial, and 35 in the deep brain region.
CMB, a kind of the cerebral small-vessel disease (CSVD), is attributed to the atherosclerosis and amyloid angiopathy. CMB might go through a silent disease process as our patient experienced impairment in the executive performance, gait function, stroke, and, then dementia over the course of two decades. MARS is a handy tool for the evaluation of CMB burden and clinical outcome. However, further research and randomized clinical trial are required to elucidate the pathophysiology and treatment guideline for CMB, especially the clinical dilemma of whether or not to use anti-thrombotic treatment in the presence of this hemorrhage-prone pathological state is unveiled.