Early and late subacute intracerebral hemorrhage (MRI)

Case contributed by Mohamed Saber

Presentation

Acute disturbed level of consciousness and right-sided weakness.

Patient Data

Age: 45 years
Gender: Female

4 days post admission

mri

MRI study shows the following:

  • left parieto-occipital cortical-based hemorrhagic lesion elicits intermediate to high signal intensity in T1WI, intermediate to low signal intensity in T2WI, extensive blooming in the GRE,  low signal in DWI, and reduced ADC value with surrounding edema and associated localized mass effect
  • bilateral cerebellar hemispheric smaller patchy hemorrhagic lesions
  • abnormal signal intensity of multiple dural venous sinuses and superficial cortical veins with blooming in GRE and loss of flow-related signal in MRV.
  • bilateral otomastoiditis (more right)

MRI picture of hemorrhagic infarctions secondary to dural sinus thrombosis.

25 days post admission

mri

Follow-up MRI study shows the following:

  • the Left parieto-occipital hemorrhagic lesion currently elicits intermediate to high signal intensity in T1, high signal intensity in T2, peripheral blooming in the GRE, high signal in DWI, and reduced ADC value diffusion with surrounding edema and associated localized mass effect
  • bilateral cerebellar hemispheric patchy hemorrhagic changes and blood products present blooming in the GRE sequence
  • recanalization of the previously thrombosed dural venous sinuses
  • bilateral otomastoiditis (more right)

Case Discussion

Here is a case that demonstrates the MRI signal, T2*, and diffusion criteria of the cerebral hemorrhage in both early and late subacute stages.

Also, follow-up of dural sinus thrombosis after treatment is clearly illustrated.

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