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Prevalence and risk factors of cerebral microbleeds

The Rotterdam Scan Study

From the Departments of Epidemiology and Biostatistics (M.W.V., M.A.I., A.H., M.M.B.B.), Radiology (M.W.V., A.v.d.L., P.A.W., W.J.N., G.P.K.), and Medical Informatics (W.J.N.), Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Address correspondence and reprint requests to Dr. Monique M.B. Breteler, Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands m.breteler{at}erasmusmc.nl

Background: Cerebral microbleeds are focal deposits of hemosiderin that can be visualized with MRI. Little is known on their prevalence in the general population and on their etiology. It has been suggested that, in analogy to spontaneous intracranial hemorrhage, the etiology of microbleeds differs according to their location in the brain, with lobar microbleeds being caused by cerebral amyloid angiopathy and deep or infratentorial microbleeds resulting from hypertension and atherosclerosis. We investigated the prevalence of and risk factors for microbleeds in the general population aged 60 years and older.

Methods: This study is based on 1,062 persons (mean age 69.6 years) from the population-based Rotterdam Scan Study. MRI was performed at 1.5 T and included a sequence optimized to increase the conspicuity of microbleeds. We assessed the relation of APOE genotype, cardiovascular risk factors, and markers of small vessel disease to the presence and location of microbleeds with multiple logistic regression.

Results: Overall prevalence of cerebral microbleeds was high and increased with age from 17.8% in persons aged 60-69 years to 38.3% in those over 80 years. APOE 4 carriers had significantly more often strictly lobar microbleeds than noncarriers. In contrast, cardiovascular risk factors and presence of lacunar infarcts and white matter lesions were associated with microbleeds in a deep or infratentorial location but not in a lobar location.

Conclusion: The prevalence of cerebral microbleeds is high. Our data support the hypothesis that strictly lobar microbleeds are related to cerebral amyloid angiopathy, whereas microbleeds in a deep or infratentorial location result from hypertensive or atherosclerotic microangiopathy.

Abbreviations: CAA = cerebral amyloid angiopathy; FLAIR = fluid-attenuated inversion recovery; GRE = gradient-recalled echo; ICH = intracerebral hemorrhage; PD = proton density.

The Rotterdam Study is supported by the Erasmus MC University Medical Center and Erasmus University Rotterdam; the Netherlands Organization for Scientific Research; the Netherlands Organization for Health Research and Development; the Research Institute for Diseases in the Elderly; the Ministry of Education, Culture, and Science; the Ministry of Health, Welfare, and Sports; the European Commission (DG XII); and the Municipality of Rotterdam. This study was further supported by Netherlands Organization for Scientific Research Grants 948-00-010 and 918-46-615.

Disclosure: The authors report no conflicts of interest.

Received July 18, 2007. Accepted in final form December 5, 2007.

This article has been cited by other articles:

				M. W. Vernooij, A. van der Lugt, and M. M.B. Breteler Risk of Thrombolysis-Related Hemorrhage Associated With Microbleed Presence Stroke, July 1, 2008; 39(7): e115 - e115. [Full Text] [PDF]

				Cerebral Microbleeds in Elders Journal Watch Neurology, June 10, 2008; 2008(610): 2 - 2. [Full Text]