INTRA CRANIAL HEMORRHAGE- AGING BLOOD ON MRI

Here are a few easy cases to explain how to age intracranial hematoma using MRI sequences.

1. INTRA CRANIAL HEMORRHAGE AGING BLOOD ON MRI DR. SHREYA SHUKLA CASES WITH EXPLANATION

2. Case 1

3. Case 2

4. Case 3

5. Case 4

6. HYPERACUTE- < 24 HRS OLD- WATER RICH CLOT (PLASMA+ PLATETLETS+ RBCS) - 97- 98 % OXY-HB (RED) CT- HYPERDENSE T1- ISOINTENSE T2- BRIGHT SWI- BLOOMS DWI- BRIGHT ADC- DARK

7. ACUTE- 1- 3 DAYS OLD – RBCS CONTAINING INTRACELLULAR DEOXY-HB (BLUE)– CONVERSION FIRST OCCURS IN THE INTENSELY HYPOXIC CENTRE CT- HYPERDENSE T1- ISOINTENSE T2- DARK SWI- BLOOMING DWI – DARK ADC – DARK

8. EARLY SUBACUTE – 3 TO 7 DAYS OLD – RBCS WITH I/C MET- HB (YELLOW) CT- ISODENSE T1- BRIGHT T2- DARK SWI- VERY DARK DWI – DARK ADC- DARK

9. LATE SUBACUTE- 7 DAYS TO MONTHS – LYSED RBCs WITH E/C MET- HB WHICH IS EXPOSED DIRECTLY TO PLASMA WATER CT- HYPODENSE T1- BRIGHT T2- BRIGHT SWI- DARK RIM, VARIABLE CENTRE DWI- BRIGHT ADC – DARK

10. CHRONIC - > MONTHS – CLOT SHRINKS- RESIDUAL FLUID SURROUNDED BY HEMOSIDERIN CT- HYPODENSE T1- DARK T2- DARK SWI- DARK DWI- DARK ADC- DARK

11. T1 BRIGHT T2 DARK EARLY SUBACUTE

12. b AGE??

13. BETTER NOW??

14. ??

15. HEMORRHAGIC TRANSFORMATION IN SUBACUTE INFRACT

16. HEMORRHAGIC TRANSFORMATION IN SUBACUTE INFRACT Occurs in first 4 days of infarct Mostly follow reperfusion therapy Poor prognosis Multifocal Look at surrounding brain- shows established infarct, follows vascular territory, cortex as well as WM is involved, indicating cytotoxic rather than vasogenic edema

17. A ? B? C?

18. A- HT in subacute infract B- primary hematoma C- hemorrhagic metastasis

19. A- NCCT showing Left putaminal and Internal capsule hematoma with mild surrounding edema. Old parieto - occipital infarct is seen posterior to this. B- small focus of enhancement on CTA- ‘spot sign’ C- post- contrast CT shows enlargement of spot – extravasation of contrast. D- NCCT- one day later – enlargement of hematoma, intraventricular spread.

20. SPOT SIGN unifocal or multifocal CE within an acute primary ICH visible on CTA discontinuous from adjacent normal or abnormal blood vessels  not present on pre-contrast images corresponds to a site of active, dynamic haemorrhage independent predictor of ICH growth and poor outcome

21. REFERENCE THANKS