Occipital lobe hematoma

Occipital lobe hematoma, in an elderly patient with prominent dilated perivascular spaces and extensive cerebral amyloid angiopathy (chronic microbleeds). A large left-sided parenchymal hemorrhage is seen on CT and MR. The CT was acquired 6 days prior to the MR exam. On MR, there is only mild accompanying vasogenic edema (seen best on the T2-weighted scan). The lesion has peripheral high signal intensity on the T1-weighted scan, consistent with intracellular methemoglobin, and diffuse low signal intensity on the T2-weighted scan, consistent with deoxyhemoglobin. There is a small amount of intraventricular hemorrhage. Prominent dilated perivascular spaces are present in the supraventricular white matter. Susceptibility weighted imaging (SWI) reveals innumerable focal low signal intensity microbleeds (hemosiderin deposits), predominantly subcortical in location, consistent with extensive amyloid angiopathy and felt in this patient to be the etiology of the parenchymal hemorrhage. Note that these are poorly depicted on the heavily T2-weighted fast spin echo scan. Amyloid angiopathy is a common cause of lobar, parenchymal hemorrhage in elderly patients.

Occipital lobe hematoma, in an elderly patient with prominent dilated perivascular spaces and extensive cerebral amyloid angiopathy (chronic microbleeds)

Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015)