Case Images
Case Notes
History
87 yo female with history of atrial fibrillation and chronic hypertension that presented with an acute seizure.Exam
Prior Study
CT head pre and post contrast, Non contrast head T1-w MR, Post contrast T1-w MR, T2-w spin echo MR, MR flairDicom
Findings
| MR susceptibility (SWI) | Correct Answer | Your Answer |
|---|---|---|
|
There is evidence (positive susceptibility artifact) of acute or prior subarachnoid blood. |
No | NA |
|
There is evidence (positive susceptibility artifact) of acute or prior intraaxial hemorrhage. |
Yes | NA |
|
There is evidence (positive susceptibility artifact) of acute or prior intraventricular blood. |
Yes | NA |
|
There is evidence (positive susceptibility artifact) of acute subpial blood. |
No | NA |
|
There is evidence of multicentric sites of parenchymal hemosiderin consistent with: chronic hypertensive encephalopathy, cavernous angiomata, amyloid angiopathy, or prior radiotherapy. |
Yes | NA |
|
There is "blooming susceptibility artifact" over arteries consistent with recent thrombosis. |
No | NA |
|
There is "blooming susceptibility artifact" over cortical or deep veins consistent with recent thrombosis. |
No | NA |
|
There are multicentric sites of pial surface microhemorrhages (result of mainly diapedesis rather than overt hemorrhage); evident in herpes simplex encephalitis, microhemorrhage in hypo-coagulopathy states. |
No | NA |
|
Other significant imaging findings are present. |
No | NA |
Impression
Expert Answer
MR susceptibliity (SWI) is sensitive to the presence of both deoxy-Hgb and hemosiderin. The SWI displays sensitivity but less "blooming artifact" with deoxy-Hgb. The SWI displays great sensitivity, but also prominent "blooming artifact" with hemosiderin.
Your Answer
Recommendations & Acuity
Recommendations
Expert Answer
Proceed with additional MR imaging sequences.
Your Answer
Acuity
Expert Answer
Emergent (Action Necessary now)
