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Cerebral microbleeds: from depiction to interpretation
  1. Laurent Puy1,
  2. Marco Pasi1,
  3. Mark Rodrigues2,
  4. Susanne J van Veluw3,
  5. Georgios Tsivgoulis4,
  6. Ashkan Shoamanesh5,
  7. Charlotte Cordonnier1
  1. 1Department of Neurology, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, F-59000 Lille, France
  2. 2Centre for Clinical Brain Sciences, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, Midlothian, UK
  3. 3Neurology Department, Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts, USA
  4. 4Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
  5. 5Department of Medicine (Neurology), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada
  1. Correspondence to Dr Charlotte Cordonnier, Lille University Hospital Center, 59000 Lille, Hauts-de-France, France; charlotte.cordonnier{at}


Cerebral microbleeds (CMBs) are defined as hypointense foci visible on T2*-weighted and susceptible-weighted MRI sequences. CMBs are increasingly recognised with the widespread use of MRI in healthy individuals as well as in the context of cerebrovascular disease or dementia. They can also be encountered in major critical medical conditions such as in patients requiring extracorporeal mechanical oxygenation. The advent of MRI-guided postmortem neuropathological examinations confirmed that, in the context of cerebrovascular disease, the vast majority of CMBs correspond to recent or old microhaemorrhages. Detection of CMBs is highly influenced by MRI parameters, in particular field strength, postprocessing methods used to enhance T2* contrast and three dimensional sequences. Despite recent progress, harmonising imaging parameters across research studies remains necessary to improve cross-study comparisons. CMBs are helpful markers to identify the nature and the severity of the underlying chronic small vessel disease. In daily clinical practice, presence and numbers of CMBs often trigger uncertainty for clinicians especially when antithrombotic treatments and acute reperfusion therapies are discussed. In the present review, we discuss those clinical dilemmas and address the value of CMBs as diagnostic and prognostic markers for future vascular events.

  • cerebrovascular disease
  • stroke
  • cognition
  • MRI

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  • Contributors PL, MP, MR, SJvV, GT, AS and CC contributed to the conception and structure of the review, drafted the text and prepared the figures.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AS reports grants and personal fees from Daiichi Sankyo Inc., grants and personal fees from Bayer AG, grants and personal fees from Servier Canada Inc., grants from Bristol-Myers Squibb, outside the submitted work; CC reports grants and personal fees from Boehringer-Ingelheim (speaker fees), BMS (steering committee), French ministry of health (grant A3ICH trial).

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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