Imaging intracranial hemorrhage – Case 7 – Venous infarct

Whenever you see hemorrhage in an unusual distribution, such as bilateral involvement, or involvement across vascular boundaries, you might think about venous infarct. Venous infarcts are often characterized by hemorrhage in unusual distribution or location.

When you are suspicious, you should look closely at the veins on MRI as well as consider CT venogram or MR venogram. This patient has hemorrhage in the left occipital lobe and left cerebellum, with hemorrhage in the left transverse sinus. The unusual edema in the right basal ganglia is also a clue.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging intracranial hemorrhage – Case 6 – Cerebral amyloid angiopathy – CAA

In patients over 70, amyloid angiopathy can be a cause of intracranial hemorrhage. This condition is caused by pathologic accumulation of amyloid in vessel walls, and is characterized by multiple chronic areas of hemorrhage in a peripheral location.

Other cerebral manifestations of amyloid also occur, including:
amyloidoma – a tumorlike mass with surrounding edema
inflammatory amyloid – an inflammatory condition similar to an acute encephalopathy.

There is sometimes overlap between these conditions. Amyloid is associated with Down syndrome as well as Alzheimer disease, which should make you more on the lookout for this condition.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging intracranial hemorrhage – Case 5 – Cavernous malformation

Cavernous malformations can also be a cause of hemorrhage. You should be alert to this, particularly in a patient who has multiple areas of hemorrhage of various ages.

This patient has a lesion which has hemorrhaged in addition to other lesions which are classic for cavernous malformations. These lesions have central T2 hyperintensity with surrounding susceptibility. Classically, these lesions demonstrate little or no enhancement, although you may see some. They are also classically described as angiographically occult (not seen) lesions.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging intracranial hemorrhage – Case 4 – Arteriovenous malformation – AVM 

This patient has a cerebellar hemorrhage. On CT angiography, there is an enhancing mass of vessels right along the tentorium which is suspicious for an underlying AVM. Conventional angiography confirms the abnormality.

AVMs are graded by their size, involvement of eloquent cortex, and venous drainage using the Spetzler-Martin grading scale. This gives a measure of operative mortality from removing the lesion and helps guide management.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging intracranial hemorrhage – Case 3 – PRES – posterior reversible encephalopathy syndrome

Sometimes other features give you a clue as to why a patient may have hemorrhage. This patient with melanoma history was certainly concerning for metastatic disease. However, there was no underlying enhancing lesion and there were multiple other areas of white matter edema, also without enhancement.

The recent history of chemotherapy made this case suspicious for PRES, posterior reversible encephalopathy syndrome, also sometimes called acute hypertensive encephalopathy. It can be a bit confusing, because it isn’t always posterior, reversible, or encephalopathy. Hence the confusing number of names.

However, conservative management in this patient showed resolution of the majority of the findings within 4 weeks without metastatic disease.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging intracranial hemorrhage – Case 2 – Metastases

This patient has a solitary hemorrhage in the right posterior frontal lobe. On MRI, there is a ring-enhancing lesion in this location, as well as other suspicious tiny lesions. Further systemic revealed a lung mass, and this patient has brain metastases with hemorrhage.

Metastatic disease is an important consideration in hemorrhage, especially in older patients. This makes contrast enhanced MRI a valuable tool in identifying the underlying etiology.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging intracranial hemorrhage – Case 1 – Hypertensive hemorrhage

This is a classic case of hypertensive hemorrhage. It’s location in the basal ganglia and thalamus with intraventricular extension is typical. The patient is somewhat young, which would suggest you complete a workup with CTA and MRI to look for underlying lesions, but in this case no lesion was found.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.