Pure Sensory Stroke Caused by Acute Symptomatic Thalamic Cerebral Microbleed with Perilesional Edema

Abstract

Cerebral microbleeds (CMBs) have conventionally been considered asymptomatic. However, several reports have suggested that CMBs may cause clinical symptoms that mimic lacunar infarction. Herein, we present a 48-year-old woman who developed pure sensory stroke caused by an acute symptomatic CMB with perilesional edema in the right thalamus. Her sensory symptoms started with left cheiro-oral syndrome and then extended to left facio-brachio-crural syndrome over time. The symptoms resolved following the exact reverse order of their extension, suggesting that the clinical symptoms correlated to the extent of perilesional edema. The hyperintense rim observed on the previous diffusion-weighted and T2-weighted images disappeared on the follow-up magnetic resonance (MR) images performed 5 months after the symptom onset. Our findings suggest that CMBs can mimic lacunar infarcts and also stroke progression. Early acquisition of MR imaging, including gradient-echo or susceptibility weighted image sequences, may be useful in distinguishing lacunar infarction and CMBs.