Intracerebral hemorrhage [431], Reason for Study: ^Reason: evaluate old hemorrhage v cavernoma History: susceptibility on previous MRI Redemonstration of encephalomalacia with gliotic change on the left precuneus chronic ICH. On gadolinium enhancement, there is no significant enhancement seen within or around this lesion.On gradient echo images, there are stippled susceptibility lesions within the lesion as well as surrounding low signal intensities indicating hemosiderin deposition. However, the overall MR feature of hemosiderin deposition is not usual popcorn appearance for cavernous malformation.This is unusual intra-axial hemorrhagic foci, if AVM is one of the possible diagnosis, diagnostic catheter angiogram needs to be considered. Gadolinium-enhanced MRI cannot exclude the possibility of brain AVM.There is no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. The right PCA is fetal origin. No intracranial arterial aneurysm. No intracranial arterial luminal stenosis is seen.
1. Usual evolution of left precuneus ICH with hemosiderin deposition as described above.2. No abnormal enhancement on the scan.3. No evidence of acute hemorrhagic or ischemic lesion.4. Normal brain MRA.5. Diagnostic catheter angiography need to be considered if brain AVM is a potential diagnosis.