Neuroimaging in Intracerebral Hemorrhage

Abstract

Hemorrhagic stroke accounts for 15% of all strokes but results in nearly a third of the mortality. Neuroimaging forms the mainstay in diagnosis, which has resulted in improved treatment outcomes. The mandate of neuroimaging includes management, risk assessment, prognostication, and research. This involves rapid identiication not only to direct treatment but also to discover the underlying etiology such as vascular malformations or tumors, monitor the evolving course of the hemorrhage and rapidly identify complications. While computed tomography (CT) remains the imaging of choice to rapidly detect acute hemorrhage, growing evidence shows that magnetic resonance imaging (MRI) is comparable to CT for detecting blood in the immediate seting and superior in this regard at subacute and chronic time points. Several advances have been made in the image sequencing protocols to detect bleeds at varying time points and to distinguish possible etiology. Initial and serial imaging is used to identify patients who may beneit from intervention. Advances in this ield such as difusion tensor imaging and functional MRI are being studied for their impact in understanding the extent of injury and possible recovery mechanisms, possibly allowing prognostication for patients.

Anterior Inferior Cerebellar Artery Aneurysm Mimicking a Vestibular Schwannoma

“…In this case, based on imaging obtained at multiple time points, we believe that there was a sudden hemorrhage into the aneurysm at the time of the initial presentation, causing the presenting symptoms. Subsequent imaging neatly followed the expected evolution of T1 signal for blood products - hyperacute: isointense, subacute: bright, and chronic: dark [ 5 ].…”