Brain imaging from a 75 year old woman presenting six weeks after a left hemisphere stroke. Brain imaging from a 75 year old woman presenting six weeks.

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QUESTION 1: name the a) study and b) orientation Answers: A) This is a CT scan of the head B) This is in the coronal plane * The dark areas are the paranasal.

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Brain imaging from a 75 year old woman presenting six weeks after a left hemisphere stroke. Brain imaging from a 75 year old woman presenting six weeks after a left hemisphere stroke. (A) CT scan. (B) Fast spin echo T2 MR scan. (C) Gradient echo MR scan. Note on the CT scan (A) the lucent areas consistent with small vessel disease. The lucent area in the left hemisphere would be consistent with the symptoms and looks like an infarct. The MR (B, C) obtained on the same day shows not only more small vessel ischaemic changes (white spots) but also haemorrhage (dark area arrowed) in the left lentiform nucleus. The haemorrhage is more readily identified on the gradient echo MR (C) than on the fast spin echo T2 (B). On the latter, old haemorrhage may easily be overlooked. There are also several old microhaemorrhages visible on the gradient echo MR (black dots) and an incidental small calcified lesion in the occipital lobe (arrowhead). J M Wardlaw J Neurol Neurosurg Psychiatry 2001;70:i7-i11 ©2001 by BMJ Publishing Group Ltd