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