Stroke Program, Department of Medicine, University of Alberta, Edmonton, T6G 2G3, Canada.
The Neuroscience Institute (Stroke Center for Excellence), Hamad Medical Corporation, Doha, 3050, Qatar.
Transl Stroke Res. 2019 Oct;10(5):449-457. doi: 10.1007/s12975-018-0678-z. Epub 2018 Dec 15.
Cerebral microbleeds (CMBs) are very frequent diagnoses with MRI imaging in the elderly or in patients with cerebral infarction, intracranial hemorrhage (ICH), and dementia. The mechanisms for CMBs are not fully understood but may be secondary to injury to the vascular wall from long-standing hypertension or amyloid deposition in the tissue. The presence of CMB increases the risk for stroke, dementia, and death. The increasing number of CMBs is also associated with a higher risk of hemorrhagic complications with the long-term use of anticoagulants in atrial fibrillation and in patients requiring thrombolysis for acute stroke. The presence of CMBs is however not a contraindication for anticoagulation or thrombolysis as was recently shown from the results of the CROMIS-2 study. This review will summarize our current understanding of the natural history of CMBs and offer suggestions on the best management in common clinical settings.
脑微出血 (CMBs) 在老年患者或伴有脑梗死、颅内出血 (ICH) 和痴呆的患者中，通过 MRI 成像经常可以做出诊断。CMBs 的发病机制尚不完全清楚，但可能继发于长期高血压引起的血管壁损伤或组织中的淀粉样物质沉积。CMBs 的存在会增加中风、痴呆和死亡的风险。CMBs 数量的增加也与长期使用抗凝剂治疗心房颤动和急性中风需要溶栓治疗的患者发生出血并发症的风险增加相关。然而，正如 CROMIS-2 研究的结果最近所表明的那样，CMBs 的存在并不是抗凝或溶栓的禁忌证。本综述将总结我们目前对 CMBs 自然史的认识，并就常见临床情况下的最佳治疗管理提出建议。
