Female, 66 years old, with confusion, left-sided weakness and vision changes. Assess for right occipital hemorrhage of unclear etiology in the setting of ALL. A hematoma is evident within the right occipital lobe measuring 27 x 18 x 16 mm. Internal signal characteristics are compatible with acute blood product (predominantly deoxyhemoglobin). Moderate vasogenic edema is seen surrounding the hematoma, which mildly effaces the right ventricular atrium, but without significant generalized mass effect. Trace subdural blood product is also seen along the right occipital and temporal lobes and along the right tentorium.Within the limits of this noncontrast examination, no definite underlying lesion can be seen in the vicinity of the hematoma. Elsewhere, patchy predominantly periventricular white matter T2 hyperintensity is seen without significant mass effect. No additional areas of intracranial hemorrhage are suspected. The ventricular system is otherwise within normal limits.On MRA imaging, no evidence of any vascular lesion is seen in the vicinity of the occipital lobe hematoma. No significant vascular stenosis or occlusion is suspected. No aneurysms are detected within the limitations of technique. Although a dedicated MRV could not be performed due to patient tolerance, the T2 flow voids of the dural venous sinuses appear to be preserved compatible with patency.
1.An acute hematoma is evident within the right occipital lobe inducing moderate vasogenic edema but without significant generalized mass effect.2.No clear underlying etiology for the hematoma is identified on this examination, including no evidence of any vascular lesion on MRA imaging.3.The differential diagnosis would include hemorrhage related to coagulopathy. Less common etiologies would include vasculitis or intravascular involvement by leukemia which can produce vessel rupture. A leukemic parenchymal chloroma can also present with hemorrhage. Parenchymal hemorrhage has been reported as a rare complication of therapy. Finally, an invasive fungal infection such as aspergillus could produce a parenchymal hemorrhage.