Cerebral microbleeds and stroke: more questions than answers

With the widespread availability of MRI scanning, cerebral microbleeds (CMBs) are being increasingly recognised in patients with stroke and in healthy individuals. As CMBs are commonly viewed as markers of increased risk of intracerebral haemorrhage (ICH), there are concerns regarding the use of antithrombotic agents (antiplatelets, and especially anticoagulants) in the presence of CMBs, even in patients at high risk of ischaemic events. The use of antiplatelet or anticoagulant therapy in the presence of CMBs, balancing the risk of recurrent ischaemic stroke against the risk of possible intracranial bleeding, is one of the most contentious contemporary issues in stroke medicine.