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Intracerebellar hemorrhage - hyperacute

Case contributed by Abdulmajid Bawazeer

Presentation

Known case of hypertension and diabetes mellitus came comatose with no history of trauma.

Patient Data

Age: 60 years
Gender: Male

There is an intracerebellar relatively large solitary area which appears isointense on T1WI and hyperintense on T2WI with low signal on diffusion-weighted imaging and blooming artefact on SWI surrounded by edema however no enhancement after contrast administration.

Case Discussion

Using known MRI blood aging appearances to estimate the timing of hemorrhage is possible even though the history, in this case, is helpful. The blood appears isointense on T1WI and hyperintense on T2WI with low signal of diffusion-weighted imaging reflects a hyperacute hematoma; see ageing blood on MRI (mnemonic).

Primary hemorrhages are common, particularly in the elderly. The basal ganglia is the most commonest site of bleeding followed by the thalamus, cerebral hemispheres, brain stem and lastly cerebellum.

In this instance, it would be essential to follow up the patient (assuming they survive) to ensure no underlying abnormality is present. This is particularly important if there is no history of hypertension. 

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