Lobar haemorrhage

Case contributed by A.Prof Frank Gaillard

Presentation

2 months personality change

Patient Data

Age: 80 Years
Gender: Female
Modality: CT

 

A mass is present within the left frontal lobe. This has a hyperdense centre and on postcontrast imaging there is rim enhancement. There is oedema of the white matter tracts of the frontal lobe. Mass effect on the cortical sulcal and gyral pattern is present. The mass appears intra-axial rather than extra-axial in location. This would be best confirmed with MRI. No further enhancing mass lesions are identified.

There is no intracerebral or subarachnoid haemorrhage. There is no extra-axial collection.

The basal cisterns and ventricles are unremarkable in their anatomy. There is minor ventricular dilatation and cortical sulcal widening in keeping with cerebral parenchymal loss consistent with the patient's age.

Symmetric densities are present within the middle cerebral arteries. There is minor periventricular white matter low attenuation in keeping with background cerebrovascular disease. The midline remains central.

There is an unremarkable appearance to the craniocervical junction and pituitary fossa. No orbital or retro-orbital abnormality is demonstrated. The visualised portions of the paranasal sinuses appear unremarkable.

Modality: MRI

Right frontal cystic cavity with heterogeneous signal and haemosiderin staining. Superficial siderosis in the anterior aspect left superior frontal gyrus and overlying anterior surface left frontal lobe. Further focus of blooming at the grey-white matter interface left temporal lobe. Associated superficial siderosis at adjacent sulci.

No associated abnormal contrast enhancement.

The right patchy periventricular and subcortical white matter FLAIR hyperintensity in keeping with chronic small vessel ischaemic disease. Diffuse parenchymal atrophy within expected limits for a patient of this age.

Time-of-flight MRA is unremarkable. No intracranial aneurysm. No abnormal vessel.

Conclusion:

Evolving left frontal haematoma with no evidence of underlying lesion.

Additional focus of haemorrhage at the grey-white matter interface left temporal lobe, suggests amyloid angiopathy as likely underlying aetiology.

 

Case Discussion

Typical appearances of a lobar haemorrhage due to cerebral amyloid angiopathy. 

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Case Information

rID: 42228
Case created: 12th Jan 2016
Last edited: 13th Mar 2016
Inclusion in quiz mode: Included

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