Presentation
Headache and ataxia.
Patient Data
A hematoma in the left cerebellar hemisphere is present with mild mass effect on the vermis and fourth ventricle, with no hydrocephalus.
There is patchy subcortical white matter hypodensity in both frontal lobes near the vertex out of keeping for age. No extra-axial collection. Muscles demonstrate no abnormal density and minimal atherosclerotic calcification.
Multiple foci of high T2 signal in the supratentorial white matter is in keeping with chronic small vessel ischemia. The residual left cerebellar hematoma is characterized as a blooming area of signal loss with the expected volume loss.
There are multiple scattered small foci of blooming signal loss (microhemorrhages) particularly on the pons, cerebellar hemispheres and basal ganglia.
The increased T2 signal in the right inferior olivary nucleus probably represents early hypertrophic olivary degeneration.
Conclusion: Findings are in keeping with chronic small vessel disease and hypertensive microangiopathy.
Case Discussion
Typical location and appearances of a hypertensive hemorrhage, with microhemorrhages in the same distribution as macrohemorrhages.
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