The Clinical,Radiological And Pathological Features And Significance Of Cerebral Microbleeds In The Elderly Patients

Objective:Cerebral microbleeds (CMBs), a small old leak of blood from damaged smallvessel of brain, were wildly known as the development of neuroimage. Although therewere a few studies on CMBs, rare had focused on the elderly patients. The exactsignificance of CMBs was still uncertain. Accordingly, we aimed to explore theclinical,radiologic and pathological features and significance of cerebral microbleedsin the elderly patients.Methods:Two hundreds and seventeen elderly patients with mean age81years, range from60to96years, who hospitalized between February2010and February2012wererecruited. Past history and laboratory examination data were collected. A1.5T magneticresonance imaging (MRI) with T1-weighted, T2-weighted, T2-FLAIR images andSWAN sequences was performed to evaluate CMBs, WML and lacunar infarcts. Thenumber of CMBs and lacunar infarcts was recorded. The severity of peri-ventricularhyperintensity (PVH) and deep white matter hyperintensity (DWMH) were assessedby modified Fazekas rating scale. Mini mental state examination(MMSE)Montrealcognitive assessmen(tMoCA) and clock drawing tes(tCDT) were performed to assessthe cognitive situation.Nighteen autopsy cases over70years between2007and2011were divided intocerebral amyloid angiopathy group (CAA) and non-CAA group. The old leak undermicroscope was recorded.Results:Among217subjects,85patients had CMBs (39.2%). The prevalence of CMBsincreased with age, the incidence was as high as50%in patients over90years old.Multipule variate regression showed that age(OR=1.677, p=0.027), hypertension(OR=5.415, p=0.004) and cerebral hemorrhage (OR=4.065, p=0.032) wereindependent risk factors of cortico-subcotical CMBs. Cerebral infarction (OR=3.376,p=0.001) was independent risk factor of deep CMBs. The proportion of CMBs obviously increased with the severity of WML andlacunar infarcts. Cortico-subcotical CMBs were only associated with age(r=0.150, p=0.027). Deep CMBs were closely related to severity of PVH(r=0.377, p＜0.001)and DWMH(r=0.336, p＜0.001)independent on hypertension. The correlationbetween deep CMBs and lacunar infarcts was dependented on hypertension.CMBs were independent risk factors of cognitive impairment in the elderly(OR=4.077, p=0.042). CMBs were associated with visuospatial skill, abstract anddelayed recall score (p＜0.05). Cortico-subcotical CMBs could cause languageimpairment with specificity (p=0.004).CMBs(OR=5.860, p＜0.001), especially the strictly lobal CMBs (OR=20.439, p＜0.001) were independent risk factors of CAA. The percent of old leak undermicroscope in CAA cases was higher than non-CAA cases.Conclusions:CMBs were common radiologic findings in the elderly patients. The prevalenceof CMBs increased with age. Age, hypertension and cerebral hemorrhage wereindependent risk factors of cortico-subcotical CMBs. Cerebral infarction wasindependent risk factors of deep CMBs.CMBs were closely associated with cerebral small vessel disease, whichindicated that they might share same angiopathy change in pathology.CMBs could lead to the cognitive impairment independently. Cortico-subcoticalCMBs were especially associated with language impairment.CMBs, especially the strictly lobal CMBs were the potential image marker ofCAA, and may predict the hemorrhage in the future.