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Age: 48

Sex: Female

Indication: Seizure, obtunded

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Case #4


Findings

  • Heterogeneous T1/T2 hyperintense lesion in the posterior right temporal lobe measuring 4.5 x 3.5 x 2 cm with associated susceptibility artifact and mild surrounding vasogenic edema with mild local mass effect resulting in partial effacement of the temporal horn of the right lateral ventricle
  • Multiple small areas of restricted diffusion involving the posterior aspect of the left lentiform nucleus, left gyrus rectus, right postcentral gyrus, posterior left cingulate gyrus, right fusiform gyrus, and left cerebellar hemisphere
  • Multiple foci of susceptibility artifact involving the bilateral cerebral and cerebellar hemispheres as well as the midbrain and pons
  • Extensive patchy T2/FLAIR hyperintensity in the subcortical and periventricular white matter
  • Age-advanced generalized cerebral atrophy
  • Dilated perivascular spaces in the bilateral basal ganglia
  • Polyp/mucous retention cyst in the inferior aspect of the left maxillary sinus


Diagnosis

  • Hemorrhagic stroke

Sample Report

Acute intraparenchymal hematoma in the posterior right temporal lobe measuring 4.5 x 3.5 x 2 cm (calculated volume = 16 mL) with mild surrounding vasogenic edema and resultant mild local mass effect resulting in partial effacement of the temporal horn of the right lateral ventricle. No midline shift or evidence of herniation or hydrocephalus. Given location and the presence of multiple small additional acute infarcts, this is favored to represent hemorrhagic transformation of an infarct. Hypertensive hemorrhage is thought less likely given location.

Multiple small acute infarcts involving the bilateral cerebrum and left cerebellar hemisphere without additional sites of hemorrhagic transformation.

Multiple foci of susceptibility artifact involving the bilateral cerebral and cerebellar hemispheres as well as the midbrain and pons, compatible with sequela of prior microhemorrhage. While amyloid angiopathy could have this appearance, this would be atypical for patient age.

Age-advanced generalized cerebral atrophy and small vessel disease.


Discussion

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Images

Posterior right temporal parenchymal hematoma nicely delineated on this gradient sequence (red arrows). Evolution of parenchymal hematoma T1 and T2 signal over time.



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