Neurology. Apart from offering hints on AD pathophysiology, their presence may modify the course of the disease and even the response to new immunotherapeutic agents. Matsusue E, Inoue C, Matsumoto K, Tanino T, Nakamura K, Fujii S. Yonago Acta Med. Indeed, global cognitive tests (like MMSE) may not capture impairment in certain domains such as executive function. This deposition of this "foreign" material can occur all along the CNS, including the brain and the spine. PubMed Central [Clinical features of superficial siderosis]. Typical clinical findings for the classical type include hearing loss, ataxia, pyramidal tract signs (spasticity, paralysis) and headache. doi: 10.5114/pjr.2021.110650. Greenberg SM, Vernooij MW, Cordonnier C, Viswanathan A, Al-Shahi Salman R, Warach S, Launer LJ, Van Buchem MA, Breteler MM: Cerebral microbleeds: a guide to detection and interpretation. According to a follow-up report from the Rotterdam Scan Study, incident lobar and deep MBs have different risk factors [35], similar to what had been observed with baseline MBs [16]. PLoS One. PubMedGoogle Scholar. These phenomena provide a scientific basis to support direct clinical effects of MBs, beyond their associations with particular vasculopathies. Cookies policy. The frequency of MBs in subjects with AD varies significantly across studies (16% to 32%) [15, 4750], with a pooled proportion of 23% (95% CI 17% to 31%) [51]. (See also Overview of Iron Overload .) Epub 2016 Sep 19. The .gov means its official. The MRI-CMB concept should take account of brain iron homeostasis, and small vessel ischaemic change in later life, rather than only as a marker for minor episodes of cerebrovascular extravasation. Google Scholar. [PubMed][CrossRef]. Kumar N, Miller GM, Piepgras DG et-al. PubMed 2008, 255: 1679-1686. Nasri A, Kacem I, Sidhom Y, Djebara MB, Gargouri A, Gouider R. J Spinal Cord Med. 1 -4 The hemosiderin deposition is a consequence of recurrent and persistent bleeding into the subarachnoid space. Because the increase in iron in the brain is age related, the role of iron in age-related neurodegenerative disorders still needs investigation. AVM Accounts for 1.5-4% of all brain masses; most supratentorial Admixture of arteries, veins, and intermediate- sized vessels Vessels are separated by gliotic neural parenchyma Foci of mineralization and hemosiderin deposi- tion are common Typically superficial, wedge-shaped, with the apex directed toward the ventricle Commonly found in . Still, consensus guidelines on MB detection and interpretation have been published [9]. 1999, 30: 1637-1642. Dierksen GA, Skehan ME, Khan MA, Jeng J, Nandigam RN, Becker JA, Kumar A, Neal KL, Betensky RA, Frosch MP, Rosand J, Johnson KA, Viswanathan A, Salat DH, Greenberg SM: Spatial relation between microbleeds and amyloid deposits in amyloid angiopathy. 10.1002/ana.410300503. For the purpose of this article, we take the latter definition. Hao Z, Yang S, Yin R, Wei J, Wang Y, Pan X, Ma A. PeerJ. The clinical signs of iron toxicity in children are retarded growth, splenomegaly, cardiomyopathy, and endocrinopathies. 2019;1205:25-53. doi: 10.1007/978-3-030-31904-5_3. Because CAA is present in up to 90% of AD cases [52], it may be conceptually feasible to state that lobar MBs are reliable markers of CAA in patients with AD. 2010, 68: 545-548. Neurology. Treatment of SS involves identification and surgical correction of the bleeding source. Bayer AJ, Bullock R, Jones RW, Wilkinson D, Paterson KR, Jenkins L, Millais SB, Donoghue S: Evaluation of the safety and immunogenicity of synthetic Abeta42 (AN1792) in patients with AD. Clinical presentation. However, it is important to note that only a small proportion of AD cases (23%) actually exhibit lobar MBs [51]. 2021 Sep 27;86:e564-e573. Chichester, West Sussex: John Wiley & Sons, 2014: 396-459. Deposition of iron results in functional damage to the heart, liver, spleen, endocrine glands, and other organs, and is often fatal. 10.1212/01.WNL.0000101463.50798.0D. Cerebrovasc Dis. Kirsch W, McAuley G, Holshouser B, Petersen F, Ayaz M, Vinters HV, Dickson C, Haacke EM, Britt W, Larseng J, Kim I, Mueller C, Schrag M, Kido D: Serial susceptibility weighted MRI measures brain iron and microbleeds in dementia. Accessibility Neurology. Superficial hemosiderosis is a neurodegenerative disorder resulting from recurrent leakage of blood into the subpial space. Disorders of the special senses in the elderly. 2005, 64: 94-101. 2008;18(2):321-46, x. Would you like email updates of new search results? Associations and implications of cerebral microbleeds. For the cortical type, (transient) focal neurological symptoms are found, but also development of dementia (1). Webb AJ, Flossmann E, Armstrong RJ. Four years before his hospitalisation, a man in his 90s had a left-sided intraparenchymal cerebral haemorrhage parietally with penetration into the subarachnoid space. Neurology. 10.1161/STROKEAHA.109.548974. -. 10.1126/science.1072994. On the other hand, several population-based studies have also reported on MB prevalence in healthy older individuals, which can be as high as 23.5% [16]. 1999;20(7):1245-8. Springer Nature. View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, dural defect with spinal CSF collections/spinal cyst, fragile capillary regrowth after brain surgery, cerebellar bleeding following craniectomy, spinal surgery or lumbar puncture. Kjell Arne Kvistad (born 1960), dr.med., specialist in radiology and senior consultant. Cheng AL, Batool S, McCreary CR, Lauzon ML, Frayne R, Goyal M, Smith EE: Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds. Werring DJ, Sperling R: Inflammatory cerebral amyloid angiopathyand amyloid-modifying therapies: variations on the same ARIA?. 2012, 79: 320-326. 2003, 250: 1496-1497. Hemosiderin or haemosiderin is an iron-storage complex that is composed of partially digested ferritin and lysosomes.The breakdown of heme gives rise to biliverdin and iron. At the time the article was last revised Yahya Baba had The medical history was potentially consistent with Creutzfeldt-Jakob disease, but the 143-3protein in cerebrospinal fluid, which is used as a biomarker for the condition, was normal. Pettersen JA, Sathiyamoorthy G, Gao FQ, Szilagyi G, Nadkarni NK, St George-Hyslop P, Rogaeva E, Black SE: Microbleed topography, leukoaraiosis, and cognition in probable Alzheimer disease from the Sunnybrook dementia study. Clinically, these episodes may resemble transient ischemic attack (TIA) or seizures, depending on the negative or positive character of the symptoms. Roch JA, Nighoghossian N, Hermier M, Cakmak S, Picot M, Honnorat J, Derex L, Trouillas P: Transient neurologic symptoms related to cerebral amyloid angiopathy: usefulness of T2*-weighted imaging. Disclaimer. PubMed The https:// ensures that you are connecting to the Hemosiderosis can also occur due to excessive iron absorption, but in that case, doctors call the condition hemochromatosis Hemochromatosis Hemochromatosis is a hereditary disorder that causes the body to absorb too much iron, causing iron to build up in the body and damage organs. 2010, 74: 1954-1960. Lippincott Williams & Wilkins. It is only found within cells (as opposed to circulating in . 2008, 248: 272-277. People lose small amounts of iron every day, and even a read more . If people have a disorder that causes excessive breakdown of red blood cells within the blood vessels (for example, hemolytic anemia Aplastic Anemia Aplastic anemia is a disorder in which the cells of the bone marrow that develop into mature blood cells are damaged, leading to low numbers of red blood cells, white blood cells, and/or platelets read more ), iron released from the red blood cells can accumulate within the kidneys (renal hemosiderosis). AJNR Am J Neuroradiol. 10.1212/WNL.0b013e31826043a9. Pract Neurol. Lewis P. Rowland, Timothy A. Pedley. There are two types of SS. Federal government websites often end in .gov or .mil. This site needs JavaScript to work properly. Hemosiderosis caused by bleeding and red blood cell breakdown does not usually require treatment. PubMed Brain. 10.1161/STROKEAHA.110.595611. 1999, 20: 637-642. Individuals with MBs had a much higher prevalence of executive dysfunction than those without MBs (60% versus 30%, P=0.03). 10.1212/WNL.0b013e3181e396ea. Hemosiderin a protein compound that stores iron in your tissues can accumulate under your skin. Patients tend to also exhibit other manifestations of hemochromatosis . Neuroimaging Clin N Am. Proper recognition and timely early diagnosis of superficial siderosis allow for early care planning. Inform patients that most people with swelling in areas of the brain do not experience symptoms, however, some people may experience symptoms such as headache, confusion, 2022 Sep 2;23(17):10018. doi: 10.3390/ijms231710018. SM-R declares that he has no competing interests. From a pathophysiological standpoint, MBs appear to be the expression of a hemorrhage-prone state of the brain, which might carry a greater risk of ICH. The author has completed the ICMJE form and reports no conflicts of interest. Bookshelf Neurology. Attems J: Sporadic cerebral amyloid angiopathy: pathology, clinical implications, and possible pathomechanisms. Brant-Zawadzki (Editor), William G., Jr. Bradley (Editor), Jane Cambray-Forker (Editor). An official website of the United States government. J Alzheimers Dis. Mutations in X-chromosomal WDR45 arise de novo; however, the dominant pattern of inheritance is unusual . PubMed The pathological and radiological relationship between these findings is not resolved. Stroke. Overall, there is a male predilection (M:F 3:1) 2,5. Poels MM, Ikram MA, van der Lugt A, Hofman A, Krestin GP, Breteler MM, Vernooij MW: Incidence of cerebral microbleeds in the general population: the Rotterdam Scan Study. Unable to load your collection due to an error, Unable to load your delegates due to an error, Box and whisker plots showing relationship between the density of haemosiderin deposition and both local (. First, lobar MBs may appear only in cases with advanced CAA, and advanced CAA accounts for only around 25% of individuals with dementia [55]. Box and whisker plots showing relationship between the density of haemosiderin deposition and, MeSH Hsu W, Loevner L, Forman M, Thaler E. Superficial Siderosis of the CNS Associated with Multiple Cavernous Malformations. (2010) ISBN: 9780781791861 -. official website and that any information you provide is encrypted 10.1161/01.STR.0000126807.69758.0e. One of these studies found that the presence of at least one MB yielded a more than twofold increase, but not a significant risk of non-AD dementia [57]. 10.1161/STROKEAHA.106.477315. Hemosiderin, a blood product, deposits along the leptomeninges. Although CNS involvement in hemochromatosis may be asymptomatic and incidentally noted radiographically, patients may present with: movement disorders (e.g. Brain. Also, CAA is often reported in autopsies, which by definition reflect end-stage disease, whereas MB imaging is performed mostly in earlier stages of the disease. However, there is no definitive evidence supporting a high diagnostic value of these MB patterns for CAA/HV. Von Sattel JP, Myers RH, Hedley-Whyte ET, Ropper AH, Bird ED, Richardson EP: Cerebral amyloid angiopathy without and with cerebral hemorrhages: a comparative histological study. Following this, the patient was self-reliant but had moderate cognitive impairments. Stephan Johannes Schler (born 1967), specialist in neurology from Germany, from where he has his dr. Bethesda, MD 20894, Web Policies 3. 2006, 66: 1356-1360. In the United States, over 1 million people have read more . Unable to load your collection due to an error, Unable to load your delegates due to an error. Below are the links to the authors original submitted files for images. Magnetic resonance imaging (MRI) cerebral microbleeds (CMB) arise from ferromagnetic haemosiderin iron assumed to derive from extravasation of erythrocytes. Google Scholar. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. -, Poels MM, Vernooij MW, Ikram MA, Hofman A, Krestin GP, van der Lugt A, Breteler MM. 2012, 78: 326-333. Would you like email updates of new search results? Two early studies failed to demonstrate any influence of MBs on cognitive performance in AD cohorts [47, 49]. Ann N Y Acad Sci. Frailty, MRI, and FDG-PET Measures in an Australian Memory Clinic Cohort. CAS In a study of individuals with lobar ICH, a higher number of lobar hemorrhages at baseline (including MBs) predicted an increased risk of not only lobar ICH recurrence but also cognitive decline, functional dependence, or death in those individuals not dependent or demented by the time of admission [38]. MRI is the modality of choice for assessment and diagnosis of superficial siderosis. HV, a consequence of long-standing hypertension over the microvasculature of the brain, is pathologically defined by the presence of lipofibrohyalinosis, which affects mostly the deep penetrating arterioles. Lancet Neurol. Greenberg SM, Eng JA, Ning M, Smith EE, Rosand J: Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage. In long-standing cases, cerebellar atrophy may also be present. . On examination, a mobile mass with a . Kikuta K, Takagi Y, Nozaki K, Okada T, Hashimoto N: Histological analysis of microbleed after surgical resection in a patient with moyamoya disease. 34 Hemosiderin deposition (which included hemorrhagic lacunes and microhemorrhages) was more predominant among ischemic stroke Neurology. Superficial siderosis is thought to result from recurrent occult subarachnoid bleeds although the source of bleeding is not usually identified on imaging 1. J Alzheimers Dis. 10.1161/STROKEAHA.111.647271. 2006, 22: 8-14. Tanaka A, Ueno Y, Nakayama Y, Takano K, Takebayashi S: Small chronic hemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas. First, the aforementioned histopathological studies consisted of small series providing very limited observations, especially regarding lobar MBs and CAA. 10.1161/STROKEAHA.108.516286. Hemosiderin deposition is the consequence of recurrent or persistent hemorrhage in the subarachnoid space. 2013 The Authors. A later study on the same cohort reported that MBs were not associated with a faster rate of cognitive decline, suggesting that the increase in mortality may be related to other clinical events, like ICH [59]. Cordonnier C, van der Flier WM, Sluimer JD, Leys D, Barkhof F, Scheltens P: Prevalence and severity of microbleeds in a memory clinic setting. PMC Taken together, these data firmly provide support that microvascular damage plays a key role in cognitive impairment in older individuals living in the community. Superficial siderosis of the central nervous system with seizures onset. Programs & Resources Clipboard, Search History, and several other advanced features are temporarily unavailable. Motta vrt nyhetsbrev! Before Over the last decades, the implementation of these MRI sequences in both epidemiological and clinical studies has revealed MBs as a common finding in many different populations, including healthy individuals. Select Save target / file as and then retrieve the PDF file in, for example, Acrobat Reader. 2014, 38: 211-221. 2010;31(1):5-14. Nat Med. California Privacy Statement, Neurology. 2004, 35: 1415-1420. 2013, 8: e65663-10.1371/journal.pone.0065663. As the frequency of MBs varies enormously depending on the MRI study characteristics and the selection of the study subjects, the reported prevalence in different clinical conditions has considerably wide ranges: 47% to 80% in ICH [12, 13], 18% to 71% [12, 14] in ischemic stroke, or 17% to 46% in cognitive decline/dementia [15]. 2004, 25: 714-719. In the literature, the risk/benefit ratio of anti-thrombotic drugs in individuals with MBs is controversial, and no formal contraindications in this respect exist. Superficial hemosiderosis of the 'classical type' is a rare but potentially serious condition resulting from leptomeningeal hemosiderin accumulation on the surface of the cerebellum, around the cranial nerves and spinal cord. 2009, 72: 171-176. At present, it is indirect evidence from population-based studies that mostly supports the associations between lobar/deep MBs and CAA/HV. Higher levels of putamen haemosiderin correlated with more CMB (P < 0.003). Banerjee G, Kim HJ, Fox Z, Jger HR, Wilson D, Charidimou A, Na HK, Na DL, Seo SW, Werring DJ. 10.1159/000139661. Ann Neurol. Received 24.11.2016, first revision submitted 31.3.2017, accepted 9.5.2017. Deferiprone, which is a lipid-soluble iron chelator that can penetrate the blood-brain barrier, is reportedly effective at improving the clinical symptoms and deposition of hemosiderin. 10.1111/j.1749-6632.2002.tb04813.x. Lancet Neurol. In "classical"-type SS, hypointense MRI signals are observed in the brainstem and cerebellum with diffuse and symmetrical margins. Disclaimer. Isolated spinal cord compression syndrome revealing delayed extensive superficial siderosis of the central nervous system secondary to cervical root avulsion. From a pathological point of view, MBs are tiny deposits of blood degradation products (mainly hemosiderin) contained within macrophages and in close spatial relationship with structurally abnormal vessels. MBs were first reported in association with intracerebral hemorrhage (ICH) [11]. Hemosiderin staining can occur in people with venous ulcers, which are slow-healing or non-healing wounds caused by blood pooling in the veins. Offenbacher H, Fazekas F, Schmidt R, Koch M, Fazekas G, Kapeller P: MR of cerebral abnormalities concomitant with primary intracerebral hematomas. 10.1161/STROKEAHA.109.558197. ), The lungs and kidneys are often sites of hemosiderosis. The amyloid cascade hypothesis [53], in combination with further theories on amyloid clearance through perivascular spaces [54], supports this notion. Int J Mol Sci. 2001, 56: 537-539. Iron chelating agents have been tried with limited anecdotal success 6. Prevalence of Superficial Siderosis in Patients with Cerebral Amyloid Angiopathy. Later studies have confirmed and expanded these findings, using different study populations with different MB patterns. 10.1002/mrm.20198. 2003, 24: 88-96. Despite this, there is a possibility that AD patients with lobar MBs represent a subgroup with distinct characteristics. In some cases, it may develop in other areas of the body, such as the inside of the elbow, after intravenous iron injections. Cordonnier C, van der Flier WM: Brain microbleeds and Alzheimers disease: innocent observation or key player?. It is thus a hopeful treatment option for SS. 2010;41:S103106. Naka H, Nomura E, Wakabayashi S, Kajikawa H, Kohriyama T, Mimori Y, Nakamura S, Matsumoto M: Frequency of asymptomatic microbleeds on T2*-weighted MR images of patients with recurrent stroke: association with combination of stroke subtypes and leukoaraiosis. 2002, 977: 169-172. Associations of mixed MBs resembled the profile of strictly deep MBs. In logistic regression analyses, the presence of MBs was the only independent predictor of executive dysfunction. 2004, 52: 612-618. 10.1212/01.wnl.0000436609.20587.65. Since HV is secondary to a systemic process (hypertension), high cardiovascular mortality is expected in the context; however, CAA is a primary brain vasculopathy, with no extracerebral manifestations. The implementation of more sensitive MRI techniques for the detection of MBs, and their systematic assessment along with other imaging markers (including PET-based amyloid imaging [24]) and blood biomarkers, may provide a useful tool in the future to guide therapeutic decisions and better define subjects in a research context. The source of hemorrhage is not apparent in approximately 50% of patients despite extensive examination. PubMed National Library of Medicine Tatsumi S, Shinohara M, Yamamoto T: Direct comparison of histology of microbleeds with postmortem MR images: a case report. Acta Neuropathol. Rinsho Shinkeigaku. Tsushima Y, Aoki J, Endo K: Brain microhemorrhages detected on T2*-weighted gradient-echo MR images. Disorders that cause inflammation that lasts for an extended period, such as nonalcoholic fatty liver disease Fatty Liver Fatty liver is an abnormal accumulation of certain fats (triglycerides) inside liver cells. Causes of hemorrhage in the "classical" type include tumor, vascular abnormality, injury, and dural defect. van der Vlies AE, Goos JD, Barkhof F, Scheltens P, van der Flier WM: Microbleeds do not affect rate of cognitive decline in Alzheimer disease. 2008, 70: 1208-1214. AJNR Am J Neuroradiol. Nicoll JA, Wilkinson D, Holmes C, Steart P, Markham H, Weller RO: Neuropathology of human Alzheimer disease after immunization with amyloid-beta peptide: a case report. 10.1007/s00415-008-0967-7. 10.1212/01.wnl.0000339060.11702.dd. Finally, MBs may have some impact on current immunotherapies for AD. 2018 Jul;41(4):490-495. doi: 10.1080/10790268.2017.1329053. In contrast, strictly deep MBs were associated with vascular risk factors, lacunar infarcts, and WMH, but not with the APOE-4 allele. eCollection 2021. Use to remove results with certain terms Although data are very limited, it is conceivable that lobar MBs could predict progression to AD-type dementia but that deep MBs could anticipate the future development of vascular dementia. Brain. Methods: This was a cross-sectional study involving 37 mountaineers in 4 groups: 10 had . Vernooij MW, Ikram MA, Wielopolski PA, Krestin GP, Breteler MM, van der Lugt A: Cerebral microbleeds: accelerated 3D T2*-weighted GRE MR imaging versus conventional 2D T2*-weighted GRE MR imaging for detection. 2011, 42: 494-497. Several underlying conditions lead to the development of SS. Google Scholar. ISSN 0029-2001 (papir) ISSN 0807-7096 (nett). Conclusions: 10.1212/WNL.0b013e3182020349. On returning home, the patient developed symptoms of headache, nausea, and vomiting. AJNR Am J Neuroradiol. These results were stronger in subjects with strictly deep MBs. Neurology. 10.1038/nm840. Alz Res Therapy 6, 33 (2014). For instance, calcifications, ferritin, and melanoma may appear identical to each other based solely on imaging [5 Takada]. Hemosiderin is a strong paramagnetic material, which allows its detection when a magnetic field is applied [1]. (B) Isolated deep microbleed in the lateral aspect of the right thalamus. Nandigam RN, Viswanathan A, Delgado P, Skehan ME, Smith EE, Rosand J, Greenberg SM, Dickerson BC: MR imaging detection of cerebral microbleeds: effect of susceptibility-weighted imaging, section thickness, and field strength. Unauthorized use of these marks is strictly prohibited. Symptoms can vary depending on the distribution of hemosiderin deposition. 10.1148/radiol.2481071158. At times, a biopsy is required to distinguish melanin-induced from hemosiderin-induced hyperpigmentation. 1. Third, the implementation of more sensitive MRI sequences for MB detection will probably increase the proportion of AD patients with lobar MBs. 2013, 81: 1930-1937. (A) Multiple lobar microbleeds distributed across the temporal lobes. https://doi.org/10.1186/alzrt263. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. Cite this article. MBs were distributed mostly in the cortical areas, predominantly in the fronto-temporal lobes, and this might suggest a high prevalence of CAA in this cohort. Knudsen KA, Rosand J, Karluk D, Greenberg SM: Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. 2007, 26: 823-837. CAS Susceptibility-weighted MRI in the axial plane showed extensive hemosiderin deposition on the facies cerebralis (solid arrows), consistent with superficial hemosiderosis, numerous microhaemorrhages in the brain parenchyma (dotted arrow), most of these subcortically in the left hemisphere. Molecular markers of gliosis and tissue integrity were assessed by immunohistochemistry in brains with highest (n = 20) and lowest (n = 20) levels of putamen haemosiderin. Radiology. 2003, 9: 389-390. This site needs JavaScript to work properly. Stephan Johannes Schler, Kjell Arne Kvistad. The link you have selected will take you to a third-party website. Again, this predominant MB location matched well with the impaired cognitive areas. Hemosiderin is a strong paramagnetic material, which allows its detection when a magnetic field is applied [ 1 ]. Over time, methemoglobin breakdown products are accumulated within the macrophages as hemosiderin and ferritin. PubMed Epub 2017 Jun 5. However, at what time point mild symptoms will progress was entirely based on personal clinical and surgical experience. Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. Taken together, these observations strongly support MBs as an additional marker of SVD. Consequently, the presence of advanced CAA has been established as a potential risk factor for developing undesirable brain inflammation in AD immunotherapy. An early trial of active immunization reported some cases of severe meningoencephalitis, which prompted its termination [60]. 2022 Mar 8;10:e13101. parkinsonism, Parkinson-plus syndromes, chorea, myoclonus, ataxia, dystonia, or tremor) 3,4. ARIA-H can occur spontaneously in patients with Alzheimer's disease. Indeed, a recent study using high-field MRI found an MB prevalence as high as 78% in patients with early AD [7]. Superficial siderosis (SS) of the central nervous system (CNS) is a chronic condition consisting of hemosiderin deposition in the subpial layers of the brain (and spinal cord) due to chronic or intermittent low-grade extravasation of blood into the subarachnoid space. Direct bleeding into the tissues that is followed by breakdown of red blood cells and release of iron to the . Magn Reson Med. 10.1212/WNL.0b013e3182452928. 1996, 17: 573-578. 10.1002/jmri.21029. Cerebral microbleeds (MBs) are small chronic brain hemorrhages, likely caused by structural abnormalities of the small vessels. Background The Japanese guideline for diagnosis and classification of superficial hemosiderosis (SHS) has recently been published, for which patient medical expenses are supported by the Ministry of Health We sought to clarify the clinical features, method of diagnosis, and treatment for SHS in Japan Methods We sent a questionnaire survey to 792 medical institutes of the Japanese Society of . MBs have extraordinary importance in the context of AD. AJNR Am J Neuroradiol.