Acute Intracerebral Hemorrhage - Case 3

A 74 year-old man presented with a headache, left visual field defect and numbness on the left side.


Note the Isointense Signal on T1   Note the Isointense and Dark Signals on T2   Show the Vasogenic Edema   Note the Dark Signal on Gradient Echo

Acute Intracerebral Hemorrhage: (Left) T1-weighted axial MRI; (Middle) T2-weighted axial MRI; (Right) Gradient Echo axial MRI. Note that on the T1-weighted scan, there is an abnormality in the right parietal lobe that is isointense. The same area on the T2-weighted scan is isointense or dark with a surrounding bright signal.

This is the characteristic picture of a hyperacute hemorrhage changing to an acute (approximately 3 days old) hemorrhage on MRI. The dark signal on the T2-weighted scan represents deoxyhemoglobin whereas the isointense signal is oxyhemoglobin. The surrounding bright signal is vasogenic edema. On the gradient echo scan, the lesion is very dark - gradient echo is very sensitive to detecting hemoglobin. In this case, the hemorrhage was due to hypertension.

The findings of blood on MRI are complex and depend on timing. To learn more, review the powerpoint slide show, Blood on MRI: Time-dependent Changes.

Revised 11/05/06.
Copyrighted 2006. David C Preston.