Hyperacute intraparenchymal hemorrhage

Case contributed by Hidayatullah Hamidi
Diagnosis certain

Presentation

Difficulty in speaking for 3 hours

Patient Data

Age: 25 years
Gender: Male

T1 isointense and T2 hyperintense signal lesion (3.3 x 2 cm) showing central diffusion restriction and peripheral rim of blooming artefact (in T2* GRE sequence) in the right inferior frontal gyrus. FLAIR demonstrates a fluid-fluid level posteriorly.

Mild surrounding vasogenic edema is noted.

The rest of the brain parenchyma is normal.

Case Discussion

The images demonstrate a hyperacute intraparenchymal hemorrhage, but no MRI detectable cause was identified. An underlying vascular malformation (most likely) or tumor are likely to be present (unless there were other systemic illnesses or factors that are currently unknown e.g. malignant hypertension, trauma, drug use). 

In any case further assessment with angiography and follow-up imaging is required. 

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