Subacute hemorrhagic stroke - enhancing

Case contributed by Frank Gaillard
Diagnosis almost certain

Presentation

This patient is from a nursing home. Right sided weakness developed rapidly a few weeks ago. Non contrast CT demonstrated low density region.

Patient Data

Age: 70 years
Gender: Female

CT brain

ct
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Info

A region of irregular peripheral enhancement involves the left lentiform nucleus and internal capsule. 

MRI brain

mri
Axial
T1
Axial
T2
Axial
Gradient Echo
Axial
FLAIR
Axial
T1 C+
Axial
DWI
Sagittal
T1
Sagittal
T1 C+
Coronal
T1 C+
Coronal MR
Perfusion
MR
Perfusion
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Info

MRI of the brain demonstrates the lesion to have signal consistent with blood (high T1 and T2 centrally, peripheral hemosiderin).

MRI brain (months later)

mri
Axial
FLAIR
Axial
T2
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Info

The corticospinal tracts on the left demonstrates high T2 signal in the left cerebral peduncle with reduced volume. 

Case Discussion

This case demonstrates how vividly a resolving hematoma can enhance. 

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