PMC4899672_01
Axial brain CT (120KV, ST: 1.0mm). Scattered areas of hyperintensity are seen throughout the both hemispheres and throughout the centrum semiovale, particularly on the left. A large area of hyperintensity represents a hemorrhage with some mass effect in the left basal ganglia and caudate (A). Note calcifications in the corpus callosum and the right thalamus (B).
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Her computed tomography (CT) brain without contrast (120KV, ST: 1.0mm) revealed a left basal ganglia hemorrhage, initially thought to be secondary to hypertension (Fig. 1).
(A) MRI brain DWI: striking appearance compared to brain CT with numerous hypointense "holes" seen throughout the cortical and subcortical regions of both hemispheres. (B-D) T2 FLAIR brain MRI: Innumerable hypointense lesions in the right and left cerebral hemispheres (B). Left basal ganglia lesion is measured 2.3 cm in diameter associated with hemorrhage (C). Extensive load of brain stem and cerebellar lesions (D).
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PMC4899672_02
GRE images demonstrate multiple low-signal-intensity lesions along the subcortical medial right anterior frontal lobe, as well as the left anterior frontal lobe (A), right parieto-occipital lobe, and left paramedian parietal lobe (B).
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A subsequent brain MRI on a 3.0 T magnet (Fig. 4) done in 2010 with a gradient-echo images (GRE) sequence revealed multiple, bilateral, supratentorial as well as infratentorial lesions, with signal intensities consistent with CCMs.
PMC4899672_03
Axial brain MRI GRE images demonstrate multiple low-signal-intensity lesions seen along the left cingulum (A) and right medial superior frontal lobe (B), indicating blood products and consistent with cavernous malformations.
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Brain MRI on a 3.0 T magnet (Fig. 5) revealed multiple cortical and subcortical areas of blood products bilaterally involving the supratentorial cerebral hemispheres.
PMC4899672_04
Axial brain MRI GRE sequence showing a large area of susceptibility artifact in the posterior lateral left thalamus, consistent with blood products.
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Similar lesions were also seen in the anterior corpus callosum and the right peritrigonal white matter (Fig. 6).
Axial brain CT (120KV, ST: 5.0mm): an 8x4mm area of increased density in the left retrolenticular portion of the internal capsule, consistent with blood products.
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Brain CT (Fig. 7) confirmed blood products, and a followup brain MRI confirmed recent hemorrhage from a cavernous malformation.