Intracranial hemorrhage with fluid-fluid level

Case contributed by Dr Bruno Lorensini


Patient in use of anticoagulants due myocardial infarction, presents with lowering the level of consciousness and absence of response to the stimulus.

Patient Data

Age: 61
Gender: Male

Intracranial hemorrhage in the left frontal periventricular white matter, associated with mild peripheral edema, resulting in mass effect and subfalcine herniation to right. A fluid-fluid level is seen, and that may be associated with bleeding by coagulation disorders.

Diffuse bleeding into the ventricular system and diffuse subarachnoid hemorrhages, especially in the sylvian fissures, interhemispheric fissure and cortical sulci left.

Case Discussion

Fluid-fluid level, also know as blood-fluid level, sedimentation level or hematocrit effect, in intracranial hemorrhage seen on CT or MRI is associated with patients who have coagulopathy or who are receiving anticoagulation therapy. Coagulation disorders prevent the formation of a blood clot or their lysis, resulting in this imaging appearance.

Fluid-blood levels in acute intracerebral hemorrhage are moderately sensitive to the presence of coagulopathy and highly specific for this condition (98% specific for coagulopathy)1. Thus, an intracerebral hemorrhage with a fluid-fluid level should prompt a thorough search for coagulation disorders, identification of which may reduce the mortality in these patients.

Tumors and arteriovenous malformations have also been reported in association with fluid-fluid level in acute intracerebral hemorrhage.

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Case information

rID: 47615
Published: 24th Aug 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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