Acute Intracerebral Hemorrhage - Case 3

An 74 year old man presented with headache, a left visual field loss and numbness on the left side.

Note the Isointense Signal on T1   Note the Isointense and Bright Signals on T2   Show the Vasogenic Edema   Note the Dark Signal on Gradient Echo

Axial MRI scans: (Left) T1-weighted; (Middle) T2-weighted; (Right) Gradient Echo. Note on T1, there is an abnormality that is isointense in the right parietal lobe. The same area on T2 is isotense or dark with a surrounding bright signal. The dark signal on T2 represents deoxyhemoglobin whereas the isotense signal is oxyhemoglobin. The surrounding bright signal is vasogenic edema. On gradient echo, the lesion is very dark - gradient echo is very sensitive in detecting hemoglobin. This is the characteristic picture of  an hyperacute hemorrhage changing to an acute (approximately 3 days old) hemorrhage on MRI. The findings of blood on MRI are complex and depend on timing. To learn more, review the powerpoint slide show, Blood on MRI: Time-dependent Changes. In this case, the hemorrhage was due to hypertension. 

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