Ito Ai Ogawa, Shindo Akihiro, Ii Yuichiro, Ishikawa Hidehiro, Taniguchi Akira, Shiba Masato, Toma Naoki, Suzuki Hidenori, Tomimoto Hidekazu
Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
J Stroke Cerebrovasc Dis. 2019 Apr;28(4):e30-e32. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.050. Epub 2019 Jan 14.
Cerebral microbleeds (MBs) have been often observed due to the development of imaging devices, and are classified to deep and lobar MBs. Lobar MBs are strongly associated with cerebral amyloid angiopathy. Here, we report 3 cases of lobar MBs that developed after small cortical ischemic stroke. One case underwent carotid artery stenting for severe carotid stenosis, one was diagnosed with artery-to-artery embolism, and the other was embolic stroke of undetermined source. New small cortical infarctions were detected with diffusion-weighted magnetic resonance imaging (MRI). Initial MRI revealed no hemorrhage around the ischemic lesion on T2*-weighted gradient-recalled echo or susceptibility-weighted imaging (SWI) at the onset of stroke. Follow-up SWI after 12-20 months revealed lobar MBs in the previously detected ischemic lesions, and high-intensity lesions remained around the MBs on fluid-attenuated inversion recovery imaging. These cases revealed that cerebral MBs developed through the transformation of small cortical infarctions. All cases showed lobar MBs, and these MBs existed in the previously detected ischemic lesions at a chronic stage. Lobar MBs present around ischemic lesions may predict embolic infarcts.
由于成像设备的发展，脑微出血（MBs）经常被观察到，并被分为深部和脑叶MBs。脑叶MBs与脑淀粉样血管病密切相关。在此，我们报告3例小皮质缺血性卒中后发生的脑叶MBs病例。1例因严重颈动脉狭窄接受了颈动脉支架置入术，1例被诊断为动脉到动脉栓塞，另1例为不明来源的栓塞性卒中。通过扩散加权磁共振成像（MRI）检测到新的小皮质梗死灶。初始MRI在卒中发作时的T2*加权梯度回波或磁敏感加权成像（SWI）上显示缺血性病变周围无出血。12 - 20个月后的随访SWI显示，在先前检测到的缺血性病变中有脑叶MBs，在液体衰减反转恢复成像上MBs周围仍有高强度病变。这些病例表明脑MBs是通过小皮质梗死的转化而形成的。所有病例均显示脑叶MBs，且这些MBs存在于慢性期先前检测到的缺血性病变中。缺血性病变周围出现的脑叶MBs可能预示着栓塞性梗死。
