Question 2694
{"accessible":true,"alternatives":[{"id":13182,"text":"hypertensive arteriopathy"},{"id":13183,"text":"cerebral amyloid angiopathy"},{"id":13184,"text":"cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy"},{"id":13185,"text":"primary angiitis of the central nervous system"},{"id":13186,"text":"radiation-induced cerebral vasculopathy"}],"archived":false,"correctAlternativeId":13183,"explanation":"\u003cp\u003eSWI shows the acute intracerebral hemorrhage in the left occipital lobe, as well as a background in the contralateral hemisphere of multiple cerebral microbleeds with a posterior predominance and focal superficial siderosis. T2WI shows severe dilated perivascular spaces in the centrum semiovale. There is also perihematoma edema. \u003ca href=\"/articles/cerebral-amyloid-angiopathy-1\" title=\"Cerebral amyloid angiopathy\"\u003eCerebral amyloid angiopathy\u003c/a\u003e is the most common diagnosis that could cause these imaging manifestations.\u003c/p\u003e\u003cp\u003eThe \u003ca href=\"/articles/boston-criteria-20-for-cerebral-amyloid-angiopathy\" title=\"Boston criteria 2.0 for cerebral amyloid angiopathy\"\u003eBoston 2.0 diagnostic criteria\u003c/a\u003e for probable cerebral amyloid angiopathy are met by a combination of imaging findings: multiple strictly lobar hemorrhagic lesions (cerebral microbleed, intracerebral hemorrhage/macrobleed, convexal subarachnoid hemorrhage, or cortical superficial siderosis) or one hemorrhagic lesion plus a white matter feature (\u0026gt;20 visible perivascular spaces in a centrum semiovale, or multispot pattern of white matter hyperintensities). This patient is older than 50 years, presented with spontaneous intracerebral hemorrhage, and did not have other causes of hemorrhagic lesions in the history (such as antecedent head trauma), meeting the rest of the diagnostic criteria.\u003c/p\u003e\u003cp\u003eHypertensive angiopathy is another common cause of lobar intracerebral hemorrhage, but this diagnosis would need to be suggested by other findings not shown in these images, such as deep grey matter or brainstem microhemorrhages, lacunes, basal ganglia perivascular spaces, and patchy or confluent white matter hyperintensities.\u003c/p\u003e\u003cp\u003eIntracerebral hemorrhage is uncommon in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) but has been reported. Imaging features that would raise suspicion for CADASIL were not shown in the selected images, such as white matter hyperintensities of the subcortical anterior temporal lobes.\u003c/p\u003e\u003cp\u003eIntracerebral hemorrhage is uncommon in primary angiitis of the central nervous system (PACNS) but has been reported. Imaging features that would raise suspicion for PACNS were not shown in the selected images, such as diffusion restricting foci, parenchymal contrast enhancement, leptomeningeal contrast enhancement, or vessel wall enhancement on vessel wall imaging.\u003c/p\u003e\u003cp\u003eRadiation-induced cerebral vasculopathy can manifest with intracerebral hemorrhage but no history of prior brain neoplasm or irradiation was provided to support this diagnosis.\u003c/p\u003e","id":2694,"imageUrl":"https://prod-images-static.radiopaedia.org/multiple_choice_questions/1050/CAA_MCQ_big_gallery.jpeg","imageAttribution":{"kind":"own","user_id":150920,"user_param":"francis-deng","user_name":"Francis Deng"},"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/2694","nextQuestionPath":null,"relatedArticles":[{"id":13413,"title":"Hypertensive intracerebral hemorrhage","link":"/articles/hypertensive-intracerebral-haemorrhage?lang=us"},{"id":6691,"title":"Cerebral amyloid angiopathy","link":"/articles/cerebral-amyloid-angiopathy-1?lang=us"},{"id":28684,"title":"Hypertensive microangiopathy","link":"/articles/hypertensive-microangiopathy?lang=us"},{"id":39012,"title":"Radiation-induced cerebral vasculopathy","link":"/articles/radiation-induced-cerebral-vasculopathy?lang=us"},{"id":1027,"title":"Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)","link":"/articles/cerebral-autosomal-dominant-arteriopathy-with-subcortical-infarcts-and-leukoencephalopathy-cadasil-1?lang=us"},{"id":16200,"title":"Cerebral small vessel disease","link":"/articles/cerebral-small-vessel-disease?lang=us"}],"alsoUsedIn":[{"id":1468,"kind":"Course","title":"2023 Virtual Conference Private Use - page 1468","link":"https://radiopaedia.org/courses/2023-virtual-conference-private-use/pages/1468"},{"id":435,"title":"r24 Deng \u0026 Sharma Cerebral small vessel diseases","kind":"Inclusion","link":"https://radiopaedia.org/admin/course_inclusions/435"}],"stem":"\u003cp\u003eA 70-year-old patient with no medical history presented with generalized tonic-clonic seizure. Head CT showed intracerebral hemorrhage. Based solely on these MR images, and presuming no hemorrhage was present in the deep grey nuclei or brainstem, what is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2694"}],"attemptsPercentages":[{"alternativeId":"13184","percentage":6},{"alternativeId":"13186","percentage":1},{"alternativeId":"13183","percentage":82},{"alternativeId":"13185","percentage":2},{"alternativeId":"13182","percentage":9}],"promptToLogin":false,"questionManager":false,"articleId":"central-nervous-system-vasculitis"}