Recurrent cerebral microbleeds with acute stroke symptoms: A case report

Abstract

Rationale: Cerebral microbleeds are lesions that appear as round low signal intensity areas with a diameter of 2-5 mm on gradient echo T2-weighted sequence magnetic resonance imaging. Cerebral microblees are hemorrhages found in the brain parenchyma and they are caused by the extravasation of the blood. Although more patients with ischemic stroke are found to have cerebral microbleeds, only a few studies have evaluated other neurologic abnormalities outside of cognitive dysfunction due to cerebral microbleeds. Patient Concerns: A 73-year-old female patient had only a lacunar infarction with the development of a new microbleed whenever a new neurologic symptom occurred, without the occurrence of acute ischemic stroke. Diagnoses: A 73-year-old female patient diagnosed symptomatic cerebral microbleeds. Interventions: Brain magnetic resonance imaging was taken within a few hours of the occurrence of a new symptom and we confirmed increased cerebral microbleeds in the ventral-posterolateral area of the thalamus, consistent with the symptoms. Outcomes: This case study is meaningful because it proves that repeated occurrences of cerebral microbleeds in a specific area can induce acute ischemic stroke-like symptoms. Lessons: Cerebral microbleeds have been considered to be asymptomatic lesions thus far. However, recent studies have reported the association of cerebral microbleeds with neurological symptoms including cognitive dysfunction. This study confirmed the presence of newly formed cerebral microbleeds through imaging follow-ups whenever a symptom occurred.