PMC8383200_01
Brain CT scans showing bilateral intraparenchymal hyperdense lesions (red arrows): a small hemorrhagic spot in the post-rolandic area on the right (A) and a greater hematoma in the left pre-rolandic area (B). (C) CTA with no evidence of vascular malformations.
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F2
Brain CT revealed multiple chronic lacunar infarctions of basal ganglia bilaterally, and two acute small intraparenchymal hemorrhages, within post-rolandic subcortical region on the right side (Figure 2A) and pre-rolandic subcortical region on the left side (Figure 2B); CT angiography showed mild carotid and vertebral atherosclerosis, and no vascular malformation (Figure 2C).
Platelet function testing performed upon admission during Aspirin therapy. Marked reduction of AUC on ASPI Test, 5 U, expressing a strong platelet inhibition induced by ASA (ultra-responder patient). Expected values in healthy individuals are in brackets.
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F3
Multiplate  platelet function analysis performed upon admission revealed a very strong platelet inhibition induced by ASA; the area under the aggregation curve (AUC) on the ASPI Test was 5 U, consistent with an ultra-responsiveness to ASA, with normal platelet aggregation induced by other agonists on the ADP Test and TRAP Test (Figure 3).
Patient's MRI at follow-up. Gradient-echo T2*-weighted sequences revealed roundish lesions underlying well-known intraparenchymal hemorrhages (A, red arrows), with classic magnetic resonance appearance of cavernous venous malformations. (B,C) show multiple and similar lesions throughout subcortical white matter and basal ganglia, bilaterally.
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F4
Gradient-echo T2*-weighted sequences revealed two small roundish lesions, in the anatomical site of bilateral subcortical hematomas, with minute central nucleus of methemoglobin and dark hemosiderin rim, and without surrounding edema, consistent with cavernous venous malformations (Figure 4A). Multiple similar but smaller cavernous angiomas were detected throughout subcortical white matter on both sides, particularly in temporal and occipital lobes, and in the area of basal ganglia (Figures 4B,C).