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Early and late subacute intracerebral hemorrhage on MRI and CT

Case contributed by Yves Leonard Voss

Presentation

Headache for 6 or 7 days, anomia, apraxia, mild sensory aphasia, but no paresis, sensory loss or vision loss.

Patient Data

Age: 65 years
Gender: Male

CT ~ 4 days after symptom onset shows hyperdense intracranial hemorrhage.

MRI ~ 7 days after symptom onset shows early subacute intracranial hemorrhage.

T1w hyperintense (slowly increasing signal intensity representing more Met-Hb, presumably intracellular in intact hypoxic erythrocytes)

T2w center hypointense, surrounding hyperintense perifocal edema

SWI hypointense (susceptibility representing intracellular Desoxy-Hb and Met-Hb, both paramagnetic)

CT ~ 20 days after symptom onset shows decreasing density of late subacute intracranial hemorrhage.

MRI ~ 30 days after symptom onset shows late subacute intracranial hemorrhage.

T1w hyperintense (representing more Met-Hb, presumably extracellular resulting from destroyed erythrocytes)

T2w center hyperintense, hypointense rim, surrounding hyperintense perifocal edema.

SWI reflects T2w, hypointense rim exaggerated by blooming effect. Susceptibility representing extracellular Met-Hb, paramagnetic

Case Discussion

These images demonstrate the time course of subacute intraparenchymal hemorrhage on MRI and CT.

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Case information

rID: 55641
Published: 19th Sep 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Excluded

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