Subacute intracranial hemorrhage

Case contributed by Dr Charlie Chia-Tsong Hsu


60 year old male presented to ED with dysarthria and left arm weakness. Family report suspected stroke oversea (Pacific islands) 6 weeks ago.

Patient Data

Age: 60 years
Gender: Male

Non contrast CT head demonstrate a well demarcated low attenuation region in the right temporoparietal junction abuting the trigone of the right lateral ventricle which demonstrate peripheral enhancement on the post contrast images. Subtle mass effect is evident with minimal effacement of the adjacent trigone of right lateral ventricle. 

Imaging features on the CT and MRI depicts the appearance of a subacute intracranial hemorrhage.

Peripheral enhancement detected on both contrast enhanced CT and post contrast T1 is typically appreciated in subacute stage of intracranial haemorrphage which can persist for several months. 

Subtle mass effect can again be appreciated on the FLAIR image. There is no surrounding vasogenic edema which is another clue to the subacute nature of this hematoma. 

In the late subacute phase, the hematoma contains predominately of extracellular methemoglobin. This correlate with increase signal intensity on both T1 and T2. Peripheral T2 shortening and rimmed hypointensity on SWI corresponds to deposition of hemosiderin and ferritin. As the hematoma progress into the the chronic phase there will be progressive increase in low signal rim.  

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Case information

rID: 19872
Published: 18th Oct 2012
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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