Cerebral Microbleeds in a Small Cohort of Patients with First Ever Lacunar Stroke. A 3Tesla MRI Longitudinal Case Series

Abstract

Background: High resolution imaging may help detect early development of cerebral microbleeds (CMB) and clarify mechanisms of small vessel disease (SVD).Methods: 19 patients with lacunar stroke were recruited and 3T MRI scan was performed after the acute event and at four months. All patients were started on anti-platelet treatment after the first event. SVD severity was assessed by the age-related white matter changes (ARWMC) scale.Results; First MRI -13 patients had No or Mild SVD (ARWMC 1-2), 6 patients had Moderate to Severe SVD (ARWMC 3-6). 3/13 of NO-MILD patients and 5/6 of MOD-SEV patients have at least 1 CMB in the first scan.Only 2 patients in the MOD-SEV group showed either enlarged or additional CMB at follow up. 3 patients in the MOD-SEV group and no patients in the NO-MILD group had at least one new asymptomatic subcortical ischemic lesion in the follow-up scan.Conclusions: Rapid development of new CMB after starting antiplatelet therapy seems to be confined in patients with severe SVD only. Subclinical vascular events in patients with moderate to severe SVD occur even when antiplatelet treatment is started. Long term effects of antiplatelet treatment in MOD-SEV patients with GRE lesions must be tested.