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Basal ganglia bleed

Case contributed by: Dr Frank Gaillard
Modality: CT
Modality: MRI

Case Discussion:

Spontaneous basal ganglia bleed in a known hypertensive. CT performed on the day of presentation. MRI a few days later.

Axial non contrast CT image demonstrates a hyperdense focus centered on the globus pallidus on the left with a faint rim of low attenuation. Findings are characteristic of a basal ganglia haemorrhage. 

MRI obtained a few days later variable signal consistent with the subacute timing. The majority of the bleed demonstrates high T1 and T2 signal consistent with extracellular met-Hb, with a peripheral rim of low signal (best seen on gradient echo) representing hemosiderin. 

Time of flight MRA demonstrates the bleed as a globular region of high signal which should not be misinterpreted as flow. 

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