Presentation
Headache.
Patient Data
Innumerable foci of blooming artefact in keeping with blood products, are present predominantly in the supratentorial brain. Moderate periventricular and deep white matter FLAIR hyperintensity, greater than expected for age, most likely represents chronic small vessel ischemic change. None of these lesions have a visible hemosiderin rim on T2 sequences.
Case Discussion
The peripheral distribution of these microhemorrhages is very characteristic of cerebral amyloid angiopathy with little if any viable alternative diagnosis.
Multiple cavernomas invariable have some that are larger and visible on other sequences. They do not spare the basal ganglia.
Miliary hemorrhagic metastases would be expected to also be more random and to have some enhancement and edema.
Radiation induced micro hemorrhages can look very similar, bur are usually confined to the radiation field and have relevant history.
Hypertensive encephalopathy has microhaemorrhges of a similar appearance but confined to the basal ganglia and pons and cerebral hemispheres.
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