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It is now routine to use MRI to elucidate small minimally symptomatic brain lesions. T2*-weighted gradient-echo MRI is a widely available and easily applied technique that detects areas of remote hemorrhage, large and small. Because all brain hemorrhages leave hemosiderin deposits for the life of the patient, T2*-weighted MRI provides a lifetime record of hemorrhages (figure).
Figure. T2*-weighted gradient-echo MRIs demonstrate punctate regions of low signal in the cortical-subcortical areas (A) in a patient with probable cerebral amyloid angiopathy and in the thalamus (B) in a patient with probable hypertensive vasculopathy.
The detection of small hemorrhagic lesions (microbleeds) with MRI has been particularly useful to identify the effects of, and hence presence of, the two common disorders of the small caliber cerebral arteries that are the leading causes of hemorrhagic stroke: cerebral amyloid angiopathy (CAA) and the vasculopathy that complicates long-standing hypertension. Microbleed location on MRI can reliably distinguish between the presence of these two underlying pathologies.1 CAA manifests with microbleeds distributed in the cortical-subcortical regions …
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