Case Notes
History
56 yo female with chronic hypertension and recent cerebellar symptomsExam
MR flair
Prior Study
Pre and post contrast CT and CTA1. 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 cerebellar and deep portions of the right cerebellum. Pial collateral was derived from the right superior cerebellar artery.
Non contrast T1-w sequence
1. The modest tissue loss in the caudal right cerebellar is again evident on the T1-w sequence
2. The site of the deep cerebellar (possibly recent) hemorrhage on head CT actually demonstrates no signal on T1 indicating chronic-phase hemorrhage with hemosiderin or dense tissue calcium deposition, or both. It is not acute or even subacute blood, and is likely >2 months of age.
T2-w MR spin echo sequence
1. The modest tissue loss in the caudal right cerebellum is again evident on the T2-w sequence
2. The site of the deep cerebellar, apparently recent, hemorrhage on head CT actually demonstrates no signal on both the T2-w and the T1-w sequences indicating chronic-phase hemorrhage with hemosiderin deposition-not acute or even subacute blood likely >2months of age.