Case 7: 24-year-old man with acute IVH and intraparenchymal hemorrhage who had MR imaging and CT 12 hours apart, each approximately 72 hours after ictus.

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Presentation transcript:

Case 7: 24-year-old man with acute IVH and intraparenchymal hemorrhage who had MR imaging and CT 12 hours apart, each approximately 72 hours after ictus. Case 7: 24-year-old man with acute IVH and intraparenchymal hemorrhage who had MR imaging and CT 12 hours apart, each approximately 72 hours after ictus. Although the IVH is more easily seen on the CT scans than on the FLAIR images, the T1-weighted images show the IVH as well as the CT scans do. A, FLAIR image (6700/150/2, TI = 2200) shows a marked hypointensity, consistent with clot, in the posterior aspect of the right lateral ventricle. The linear meniscus (arrow) demarcates the posterior clot from the normal anterior CSF signal. The marked hypointensity of the IVH is most likely caused by the T2 shortening effects of intracellular methemoglobin present abundantly in the clot at this IVH stage. The hypointensity of this state of blood breakdown resembles normal dark CSF. In addition, heterogeneous signal is present in the mesial part of the right parietooccipital lobe with surrounding hyperintensity, consistent with an AVM. (Focal hyperintensity in the left lateral ventricle is most likely caused by a CSF pulsation artifact, which was also seen on control images.)B and C, Clotted IVH is markedly hyperintense and easily seen on T1-weighted image (450/20/2) (B). The IVH is markedly hypointense on T2-weighted image (2000/120/2) (C). The T1- and T2-weighted imaging appearances are consistent with the predominantly intracellular methemoglobin content of the IVH.D, Noncontrast CT scan shows calcified AVM and clotted IVH, each hyperdense. Rohit Bakshi et al. AJNR Am J Neuroradiol 1999;20:629-636 ©1999 by American Society of Neuroradiology