Incidence, Locations, and Longitudinal Course of Cerebral Microbleeds in European Moyamoya

Abstract

Background and Purpose-Cerebral microbleeds (cMBs) have previously been linked with especially high incidence in Asian patients with moyamoya together with high tendency to bleed. This, presumably, is characteristic of patients with moyamoya. Herein, we, therefore, investigate retrospectively the frequency, location, and longitudinal course of cMBs in a large German cohort. Methods-We included all patients with moyamoya who underwent standard magnetic resonance imaging, including T2*-weighted images, in our department between 1998 and 2015. Two independent readers evaluated magnetic resonance imaging scans to determine the occurrence of cMBs according to the Brain Observer Microbleed Scale. Demographics, initial symptoms leading to hospitalization, and associated diseases were obtained by chart review. Results-Overall, there was a total of 242 T2* studies of 101 included moyamoya patients available with a strong female predominance (69.3%). Eight patients (7.9%) were ≤18 years of age. We detected 25 cMBs within 13 patients (12.9%).One patient <18 of age was presented with a cMB; 2 of 3 patients with an intracranial hemorrhage as initial event demonstrated cMB(s). In 72 of 101 cases, there were 1719 person months of follow-up, with 3 adult patients showing 3 de novo cMBs in the course. The majority of cMBs (64.0%) were located at the cortex/gray-white junction. Conclusions-Although the frequency of cMBs herein is much higher than the expected age-specific incidence, it is still much lower compared with previous reports on cMBs in moyamoya patients of Asian descent. These results might reflect another ethnic-specific difference in patients diagnosed with moyamoya.

Identification of the Bleeding Point in Hemorrhagic Moyamoya Disease Using Fusion Images of Susceptibility-Weighted Imaging and Time-of-Flight MRA

“…This distribution pattern corresponds to that described in a past study that investigated bleeding using acute-phase CT 12 and also resembles the distribution of microbleeds in Moyamoya disease. 10,11 Furthermore, the choroidal artery was most frequently detected as the responsible vessel in the periventricular area. Previous studies have shown dilation of the choroidal artery and posterior communicating artery as risk factors for ICH in Moyamoya disease.…”

“…Although some reports have investigated the distribution of microbleeds in Moyamoya disease, 10,11 no reports have addressed the bleeding point and vessels responsible for symptomatic hemorrhage related to Moyamoya disease, with the exception of 1 study using head CT. 12 Determining the site from which bleeding has occurred on CT and MR imaging performed during acutephase hemorrhage is often difficult.…”

Contemporary and emerging magnetic resonance imaging methods for evaluation of moyamoya disease

“…The sequence is exquisitely sensitive to areas of chronic microhemorrhage, which are seen with an increased incidence in MMD and may be associated with increased risk of intracranial hemorrhage. 29,56,72 The brush sign of prominent deep medullary veins on SWI may be associated with likelihood of infarct, low cerebral blood flow (CBF), and low CVR. 22 Asymmetrically prominent superficial cortical vessels on SWI are associated with elevated deoxyhemoglobin content with increased oxygenation extraction; with revascularization, this finding may reverse and may predict potential to improve CBF.…”

Cerebral Microbleeds: Incidence, Imaging Characteristics, Common and Uncommon Causes

“…53 CMBs, located in deep and periventricular regions, are seen in 28-46% of cases although a recent report concerning a European moyamoya patient cohort found a lower prevalence of 12.9%. [54][55][56] Their presence is associated with dilated anterior choroidal or posterior communicating arteries. Periventricular CMBs increase the risk of intraventricular hemorrhage.…”