Basal ganglia bleed

Case contributed by Frank Gaillard
Diagnosis certain

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 a few days later


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.


How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.