PMC3122986_01
Plain axial CT image reveals large, right parietal lobe hematoma causing mild compression of posterior part of the body of ipsilateral lateral ventricle; and diffuse white matter hypodensities (leukoaraiosis)
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CT image [Figure 1] showed right parietal lobe hematoma with diffuse cerebral white matter hypodensities. Corresponding axial
Axial T1-weighted MR image demonstrates subacute right parietal hematoma and associated white matter hypointensities. Mild age-related generalized brain atrophy with prominence of cerebrospinal fluid spaces is also evident
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T1-weighted MR image [Figure 2] demonstrated subacute nature of right parietal hematoma.
T2-weighted axial image reveals diffuse, asymmetrical, confluent (grade 3) supratentorial white matter hyperintensities, being more pronounced on the right side, involving both periventicular deep white matter and subcortical U-fibers (double arrow). Multiple punctate (grade 1) hyperintense foci (single arrow) are also visible in bilateral frontoparietal and left basal ganglia region
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Axial FLAIR sequences demonstrate the lobar hematoma with irregular borders, and supratentorial white matter hyperintensities as seen in T2-weighted images
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T2FNx01-weighted gradient-echo MR images show multiple focal hemosiderin deposits (old microbleeds) in the cortical and corticosubcortical location of right frontotemporal lobe (thick downarrow), and solitary fresh microbleed in the left high posterofrontal region (thick up-arrow), seen as signal void areas (blooming). In addition, linear areas of signal void (thin arrow) in the vicinity of large primary lobar hemorrhage (double arrow) suggest subarachnoid hemosiderosis
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The white matter changes were diffuse, concomitant, confluent (grade 3), more pronounced on the right side and involved both periventicular deep white matter and subcortical U-fibers. Multiple punctate (grade 1) white matter hyperintensities were also visible in bilateral frontoparietal and left basal ganglia region. T2*-weighted gradient-echo (GRE) MR images [Figure 5] showed multiple focal hemosiderin deposits (old microbleeds) in the cortical and corticosubcortical location of right frontotemporal lobe, and solitary fresh microbleed in the left high posterofrontal region, as signal void areas, giving a characteristic "blooming effect." In addition, linear areas of signal void visible in the vicinity of the primary lobar hemorrhage, and right frontal lobe suggested subarachnoid hemosiderosis.
DWI and the corresponding ADC mapping reveal restricted diffusion within the subacute bleed. No other area in the brain parenchyma demonstrates diffusion restriction, thereby excluding acute cerebral infarct
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Although diffusion weighted imaging (DWI) and the corresponding apparent diffusion coefficient (ADC) mapping [Figure 6] revealed restricted diffusion within large lobar subacute bleed, but no other area in the brain demonstrated diffusion restriction, excluding acute infarct.