Case Notes
History
56 yo female with chronic hypertension and recent cerebellar symptomsExam
Prior Study
Pre and post contrast CT and CTA
1. The noncontrast CT demonstrates an apparent hemorrhage in an area of tissue volume loss in the caudal right cerebellar hemisphere. Age of the stroke and age of the apparent reperfusion hemorrhage are indeterminate. The apparent hemorrhage could also represent dystrophic nodular post ischemic tissue calcification.
2. There is ventriculomegaly and tissue atrophy out of proportion to age. Temporal horn size remains normal and there is no optic hydrops to confirm hydrocephalus.
3. The CTA confirmed non antegrade filling of distal arteries to the caudal right cerebellum and deep portions of the right cerebellum. Pial collateral was derived from the right superior cerebellar artery.
Dicom
Findings
MR T1-w pre contrast | Correct Answer | Your Answer |
---|---|---|
There is evidence of acute subarachnoid blood. |
No | NA |
There is evidence of acute intraaxial parenchymal blood. |
No | NA |
There is evidence of laminar necrosis from prior sequestered infarction. |
No | NA |
There is evidence of acute intraventricular blood. |
No | NA |
There is evidence of hemorrhagic intraaxial CNS tumor. |
No | NA |
There is significant local mass effect and/or evidence of brain herniation. |
No | NA |
There is evidence of met-Hgb within thrombosed or partially thrombosed saccular aneurysm, sacculofusiform aneurysm. |
No | NA |
There is evidence of single or multiple cavernous malformation(s). |
No | NA |
There is evidence of an AV shunting arteriovenous malformation. |
No | NA |
There is evidence of internal or external obstructive hydrocephalus. |
Yes | NA |
There is evidence or current or prior ischemic stroke. |
No | NA |
There is evidence of thrombosis of any extradural or intradural major artery. |
No | NA |
There is evidence of thrombus within one or more dural sinus. |
No | NA |
There is evidence of acute thrombus within intracranial veins. |
No | NA |
There is evidence of acute thrombus within intracranial arteries. |
No | NA |
There is evidence of pituitary apoplexy. |
No | NA |
Other significant imaging findings are present. |
Yes | NA |
Impression
Expert Answer
Parenchymal hemorrhages on noncontrast T1 sequences appear isointense or slightly hyperintense in the hyperacute and acute timeframe. Parenchymal hemorrhages on noncontrast T1 sequences appear hyperintense in the early and late subacute timeframe. Parenchymal hemorrhages on noncontrast T1 sequences appear hypointense in the chronic timeframe.
Your Answer
Recommendations & Acuity
Recommendations
Expert Answer
Proceed with additional MR imaging sequences.
Your Answer
Acuity
Expert Answer
Emergent (Action Necessary now)