Case Notes
History
50 yo male with an acute onset headache. He had mild hypertension, but was otherwise in reasonable health. The prior head CT performed one year earlier had demonstrated several lacunes and sulcal atrophy on the right. Exam was performed for early changes in mentation and memory.Exam
Prior Study
CT Head pre contrast1. Acute mid temporal white matter centered hemorrhage.
2. Background of a lacunar defect in the right caudate head, regional atrophy in the right cerebral hemisphere and early leukomalacia in the centrum semiovale bilaterally. These find indicate an underlying encephalopathy.
T1-w MR pre and post contrast
1. Acute mid temporal white matter centered hemorrhage with T1-w features partly in the acute phase and partly beginning the transition to met-HGB (early subacute phase).
2. Chronic lacunar defects in the right caudate head.
3. Negative MRA for underlying vascular cause of the current hemorrhage.
MR T2-w spin echo
1. Acute mid temporal white matter centered hemorrhage with T2-w features consistent with acute blood in the deoxy-Hgb phase.
2. The extensive bilateral leukomalacic changes in the centrum semiovale, the lacunar defect in the right caudate, and white matter changes that do not follow the pattern or chronic hypertensive encephalopathy raise the possibility of CADASIL or amyloid angiopathy.
MR Flair
1. Acute mid temporal white matter centered hemorrhage with MR flair findings consistent with acute blood in the deoxy-Hgb phase.
2. The extensive bilateral leukomalacic changes in the centrum semiovale, the lacunar defect in the right caudate, and white matter changes that do not follow the pattern or chronic hypertensive encephalopathy raise the possibility of CADASIL or amyloid angiopathy.
Dicom
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. |
No | 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. |
Yes | NA |