Images in Neurology
June 2011

Magnetic Resonance Imaging Characteristics at Onset of Spontaneous Intracerebral Hemorrhage

Author Affiliations

Author Affiliations: Departments of Diagnostic Radiology and Nuclear Medicine (Drs Jeong and Jhaveri) and Neurological Sciences (Dr Prabhakaran), Rush University Medical Center, Chicago, Illinois.


Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Neurol. 2011;68(6):826-827. doi:10.1001/archneurol.2011.109

A 70-year-old woman presented to our institution for a routine follow-up magnetic resonance imaging (MRI) examination to evaluate a previously coiled posterior communicating artery aneurysm. At the beginning of the MRI examination, the patient was asymptomatic. Within the scanner, the patient developed altered sensorium and right-sided weakness.

The MRI examination began with a sagittal T1-weighted sequence (Figure 1A, with a time of 19 hours and 14 minutes) that did not show any abnormality. Subsequent imaging sequences demonstrated hyperacute evolution of spontaneous intracerebral hemorrhage from its onset. An axial T2-weighted sequence (Figure 1B [time, 19 hours and 16 minutes]) demonstrates subtle hyperintensity in the left putamen. Axial fluid-attenuated inversion recovery (Figure 1C [time, 19 hours and 33 minutes]) and gradient echo (Figure 1D [time, 19 hours and 37 minutes]) sequences show a rapid increase in the size of the hyperintensity in the left putamen due to a hyperacute hemorrhage expansion. Postcontrast axial T1-weighted (Figure 1E [time, 19 hours and 48 minutes]) and sagittal T1-weighted (Figure 1F [time, 19 hours and 51 minutes]) scans demonstrate active extravasation of gadolinium and enlarging hyperacute hematoma.

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