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Review
. 2012 Mar;32(3):425-36.
doi: 10.1038/jcbfm.2011.200. Epub 2012 Jan 11.

Cerebral microinfarcts: a systematic review of neuropathological studies

Manon Brundel  1 , Jeroen de Bresser, Jeroen J van Dillen, L Jaap Kappelle, Geert Jan Biessels
Affiliations
Review

Cerebral microinfarcts: a systematic review of neuropathological studies

Manon Brundel et al. J Cereb Blood Flow Metab. 2012 Mar.

Abstract

Vascular cognitive impairment is an umbrella term for cognitive dysfunction associated with and presumed to be caused by vascular brain damage. Autopsy studies have identified microinfarcts as an important neuropathological correlate of vascular cognitive impairment that escapes detection by conventional magnetic resonance imaging (MRI). As a frame of reference for future high-resolution MRI studies, we systematically reviewed the literature on neuropathological studies on cerebral microinfarcts in the context of vascular disease, vascular risk factors, cognitive decline and dementia. We identified 32 original patient studies involving 10,515 people. The overall picture is that microinfarcts are common, particularly in patients with vascular dementia (weighted average 62%), Alzheimer's disease (43%), and demented patients with both Alzheimer-type and cerebrovascular pathology (33%) compared with nondemented older individuals (24%). In many patients, multiple microinfarcts were detected. Microinfarcts are described as minute foci with neuronal loss, gliosis, pallor, or more cystic lesions. They are found in all brain regions, possibly more so in the cerebral cortex, particularly in watershed areas. Reported sizes vary from 50 μm to a few mm, which is within the detection limit of current high-resolution MRI. Detection of these lesions in vivo would have a high potential for future pathophysiological studies in vascular cognitive impairment.

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Figures

Figure 1
Figure 1
Selection of included studies.
Figure 2
Figure 2
Photomicrographs of different types of cerebral microinfarcts. Photomicrographs showing cortical cystic microinfarcts (A, B) and a small focus of collapsed gliotic tissue (C). Material was stained with Globus silver staining (A) and hematoxylin and eosin staining (B, C). Scale bar: (A) 1,000 mm; (B) 250 mm. (Images from Gold et al, 2007 (A); Okamoto et al, 2009 (B); Strozyk et al, 2010 (C).)
Figure 3
Figure 3
Example of cortical ischemic lesions on magnetic resonance (MR) images obtained at 7 T. Fluid-attenuated inversion recovery (FLAIR) images from a 57-year-old woman with a history of atrial fibrillation who presented with aphasia and left-sided hemiparesis based on cortical ischemia in the right middle cerebral artery territory. Note the small cortical hyperintensities (arrows), which represent minute acute ischemic lesions.
See this image and copyright information in PMC

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