Differentiating between Hemorrhagic Infarct and Parenchymal Intracerebral Hemorrhage
Figure 13
54-year-old man with a history of idiopathic thrombocytopenic purpura presented with acute coronary syndrome. He developed a dense right hemiparesis overnight. (a) Initial axial unenhanced CT images show a large left “fronto-temporal hemorrhage”, initially thought to be secondary to his low platelet count of 20. Stage IIH c2 [1]. (b) Axial diffusion weighted MR images reveal areas of restricted diffusion remote from the area of hemorrhage (arrow heads). (c) The areas of diffusion weighted abnormality have low apparent diffusion coefficient values (arrows). (d) Digital probabilistic maps of middle cerebral artery territory infarcts show both the infarcts and hemorrhage lie within the middle cerebral artery territory. (e) Coronal unenhanced images from the original CT show a dense left internal carotid artery in the cavernous sinus (thin arrow). (f) MR angiogram confirms occlusion of the left internal carotid middle cerebral arteries. The overall picture suggests that the stroke is a HI.
