A 82 year old man presented with focal seizures affecting the right arm. There was a long standing history of hypertension and a history of some type of remote stroke years ago that resulted in right sided weakness that resolved over 6 months.
Axial MRI scans: (Left) T1-weighted; (Right) T2-weighted. Note on T1, there is an area of hypodensity between the putamen, anterior limb of the internal capsule and insula. The same area of T2 is also dark but have a bright center. This is the characteristic picture of remote hemorrhage with the hypointensity of T1 and T2 representing hemosiderin. The small area of bright signal on T2 is fluid which sometimes remains as a collapsed cyst following hemorrhage and destruction of brain. 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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