Micro bleed

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  1. 1. Dr.Bipin BhimaniM.D.,D.M.Consultant NeurophysicianWell care HospitalRajkot
  2. 2. Case : M / 44 yrs Sudden onset ofWeakness/ Clumsiness/ giving away of both LLS About to fall but was supported Lasted for few minutes (2-5 minutes) ? Sensory ( numbness) Recovered totally.
  3. 3. RHD/MS/BMV done 1 month ago No AF/ clot/ LA-near ok / no smoke Past h/o ? Cerebellar Stroke 2 yrs back(Admitted/No reports available) Ecospirin OD/150mg
  4. 4. ? Spinal cord TIA ? Cerebral TIA ? Symptomatic microbleed
  5. 5. Normal course:admission, observationRepeat ECHOheparinisationanticoagulants Any change in view of multiple micro bleeds ?
  6. 6. Affects many therapeuticaldecisions Aspirin Clopidogrel Asp +Dypiridamole Asp+ Clop Asp+Clop+cilastazol Anticoagulants /Heparin tPA
  7. 7. CMBs/BMBs Mid 1990s Focal hemosiderin,DOHb,Ferittin(macrophage)of previous hemorrhage ( perivascular) < 5 mm round (actually smaller) Usually BG/ SC , in CAA cortical Also cerelellum, brain stem Persists for many years
  8. 8. Fibrohyalinosis or CAA,