Presentation
Demented patient, presented with acute neurological symptoms. Patient is normotensive.
Patient Data
T1 and T2WI show multiple peripheral foci of cerebral hemorrhage which are T1 bright and variably T2 isointense or bright, representing a mixture of acute/early subacute bleeds.
T2*WI shows numerous additional foci of punctate susceptibility artifact ("black dots"), consistent with angiopathic microbleeds.
Case Discussion
Top differential diagnoses for multifocal "black dots" on T2/T2* MR include various etiologies of small hemorrhages:
- hypertensive microhemorrhages
- ischemic stroke with microhemorrhages
- multiple cavernous malformations (type 4)
- diffuse axonal injury
- hemorrhagic metastases
However, each of the above mentioned differential diagnoses has different clinical scenario and other supportive imaging features.