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.
Jeong D, Jhaveri MD, Prabhakaran S. Magnetic Resonance Imaging Characteristics at Onset of Spontaneous Intracerebral Hemorrhage. Arch Neurol. 2011;68(6):826-827. doi:10.1001/archneurol.2011.109