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 hemorrhage.
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.*
* As time of flight (TOF) MRA is a T1 weighted sequence relying on pre-saturation of non-moving tissue, very intense T1 signal material will still be visible (as seen here with the clot). This also makes TOF a poor choice for MRV as clot will appear bright and may be mistaken for flow.
Case Discussion
Spontaneous basal ganglia bleed in a known hypertensive. CT performed on the day of presentation. MRI a few days later.
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