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New microbleed after blood–brain barrier leakage in intracerebral haemorrhage
  1. Koen M van Nieuwenhuizen1,
  2. Jeroen Hendrikse2,
  3. Catharina J M Klijn1,3
  1. 1Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3Department of Neurology, Donders Institute for Brain Cognition & Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Professor Catharina JM Klijn, karin.klijn{at}


Cerebral microbleeds are increasingly recognised as biomarkers of small vessel disease. Several preclinical and clinical studies have suggested that chronic disruption of the blood–brain barrier is one of the mechanisms for the development of cerebral microbleeds.

A 51-year-old man experienced two left parieto-occipital lobar intracerebral haemorrhages (ICHs) in the timespan of 2 years. Multiple microbleeds surrounding the two haemorrhages were found on MRI, but not at location distant from the haemorrhages. Ten months after the last haemorrhage, an MRI demonstrated a right occipital focus of contrast enhancement. Twenty months after the last ICH, a new cerebral microbleed had developed exactly at the location of the earlier contrast enhancement.

This case demonstrates that blood–brain barrier disruption may be an important factor preceding the development of cerebral microbleeds.

  • Stroke
  • Radiology

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  • Contributors CJMK conceived the case report. All authors contributed to the analysis and interpretation of the case. KMvN wrote the first draft of the manuscript. CJMK and JH critically revised the manuscripts intellectual content. All authors read and approved the final version for publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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