Cerebral Microbleeds - To Treat or Not to Treat, That Is the Question: A Case Report With a Note on Its Radiologic Deconstruction and Therapeutic Nuances

With the ubiquity of susceptibility weighted imaging (SWI), cerebral microbleeds (CMBs) are fast becoming a prevalent phenomenon. They are tightly associated with age, neurodegeneration and diverse vascular etiologies. CMBs have a unique radiological signature. Their morphology, number and topology are quite informative. They also pose a therapeutic conundrum, as they are associated with the risk of cerebral hemorrhage. We present the case of an 86-year-old woman who has a vascular dementia, Binswanger's syndrome, and coronary artery disease, who presented with more than five CMBs. We present this case in order to highlight the dilemma of anti-platelet therapy in this group of patients and we demonstrate the cardinal radiologic features of CMBs. We then segue into the pathologic correlates of CMBs and associated risk factors. We finally analyze the risk of anti-platelet therapy in the presence of CMBs, and we unfold the latest data on CMB number and anti-platelet therapy.