Presentation
Sudden-onset headaches with photophobia. No neurological deficit.
Patient Data
There is a right intrasylvian hematoma measuring 50 x 35 x 30 mm with surrounding edema and a mass effect on the midline structures with associated subarachnoid hemorrhage.
On the MRI performed one week later, the intrasylvian hematoma appears isointense to the cortical grey matter with a peripheral area of high signal, hypointense on T2, FLAIR, and GE centrally and hyperintense peripherally. A small target lesion is visible at the M3 segment of the middle cerebral artery (hyperintense centrally and hypointense peripherally) which may correspond to the ruptured intrasylvian aneurysm (well-visualized on MRA source images, T1 C+, and GE). Subarachnoid hemorrhage well-visualized on FLAIR sequences with no associated intraventricular hemorrhage.
Mild surrounding edema and mass effect on the temporal and frontal lobes as well as the midline structures with dilatation of the contralateral lateral ventricle.
Small vessels ischemic changes of the white matter are noted.
Case Discussion
MRI features of an intrasylvian hematoma with subarachnoid hemorrhage probably due to a ruptured intrasylvian aneurysm of the middle cerebral artery.
A CT angiography was recommended.