Rapid Formation of Cerebral Microbleeds in Reversible Cerebral Vasoconstriction Syndrome

CMBs are most often encountered in age-related cerebral small vessel diseases (CSVDs); however, they are increasingly reported in varied cerebral vasculopathies.1 CMBs can occur rapidly in acute stroke,2 and imaging-pathology correlation studies have demonstrated intact erythrocytes, confirming recent formation in a subset.3 We report a case of rapid CMB formation in reversible cerebral vasoconstriction syndrome (RCVS). Acute CMBs have also been reported from increased vascular permeability during refractory status epilepticus,7 but in our case the seizure is unlikely to have contributed to the CMBs seen on repeat imaging, as it was brief, did not recur, and baseline MRI performed 4 days following the event was devoid of CMBs. [...]CMBs may be a third intracranial hemorrhage manifestation of RCVS and clinicians should maintain a broad differential when encountering CMBs in stroke patients.