Cerebral hemorrhage masking underlying primary glial tumor

Discussion:

This patient was not known to have hypertension or any history of a previous cerebral vascular event.

The haemorhage is not in a typical location to be classified as a 'hypertensive bleed', thus we label it as a "lobar bleed".

The patient has no other radiological evidence of microvascular disease. With the eye of faith there is possibly some faint enhancement along the left mesial temporal lobe, but it is hard to appreciate with so much high T1 signal secondary to the bleed.

Teaching point: have a high index of suspicion for a secondary cause of a bleed when the clinical context and anatomical location do not match.

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