A 52-year-old man with no medical care for 20 years presented for evaluation of resting tremor. His exam demonstrated severe hypertension and asymmetric parkinsonism. His evaluation included MRI (figure), which demonstrated multifocal low signal regions on T2*-weighted gradient echo (GRE). Follow-up head CT showed a single small cortical hemorrhage and no calcification. Follow-up MR angiogram demonstrated no vascular abnormalities. GRE can identify hemosiderin deposits indicative of previous microhemorrhages not seen on CT or other MRI sequences. Such microbleeds occur in approximately 6.4% of healthy elderly patients1 and 15.2% of neurologic and psychiatric patients with no history of symptomatic cerebrovascular disease.2
Figure. (A) Gradient echo (GRE) and (B) fluid attenuated inversion recovery (FLAIR) MR images. Multifocal low signal regions on the GRE represent prior microhemorrhages. The FLAIR image demonstrates white matter disease consistent with small-vessel ischemic injury.
Acknowledgments
Supported by grant no. K23NS02168-01 from the National Institutes of Health, National Institute of Neurological Disorders and Stroke (K.C.J.).
Footnotes
See also page 511
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
