Typical radiographic findings of intracranial hemorrhage, summarized in one article

The specific causes of intracranial hemorrhage are varied, and neuroimaging plays a pivotal role
in the diagnosis and treatment process.
This article lists typical imaging data of common causes of intracranial hemorrhage to help you better understand intracranial hemorrhage
.
Without further ado, let's look at the picture
.

Compiled and sorted out, please do not reprint
without authorization.

Figure 1

This case is traumatic subarachnoid hemorrhage
caused by a car accident.

Figure A: Plain CT shows a high-density shadow in the sulcus (long tail arrow), in addition to a subdural hematoma on the left (triangular arrow) and a cap-like subaponeurotic hematoma (dotted arrow)
at the right parietal bone.

Figure B: The MRI FLAIR sequence also shows a high signal in the sulcus, confirming the presence of subarachnoid hemorrhage, while the left subdural hematoma and the right cap-like subaponeurotic hematoma
can be seen.

Figure C: Subarachnoid hemorrhage and subdural hematoma appear as low signals
on the GRE sequence.

Figure 2

Two cases
of traumatic subdural hematomas after traffic accidents.

Figures A and B: Imaging tests
were performed in this case when the patient was in a low state of consciousness.
Hemorrhagic parenchymal contusion of the right temporal lobe is visible (Figure A, triangular arrow), while a semicircular epidural hematoma foci is visible in the anterior part of the left anterior temporal lobe (Figure A, long tail arrow).

Anterior imaging shows nondisplaced temporal fractures near the epidural hematoma (Figure B, long tail arrow).

Figures C and D: The patient in this example was in a state
of unresponsiveness when receiving imaging examination.
Translational CT shows a large biconvex epidural hematoma (long tail arrow) and a significant mass effect is seen, resulting in left midline displacement and subsickle hernia of the brain (triangular arrow), as well as cerebellar curtain incision hernia (dotted arrow).

Figure 3

In order to clearly see the lesions, some adjustments
were made to the window width of the CT.
Compared with the subdural window (Figures C, D), the lesion is less pronounced
on the standard brain window (Figures A, B).
Hemorrhagic contusion of the right anterior temporal lobe and subarachnoid hemorrhage covering the brain sulcus (triangular arrow) are shown in the figure, and arc-shaped subdural hematoma foci (long tail arrow)
are visible under the bone plate.

Figure 4

In this case, the patient had a brain herniation due to a
large subdural hematoma.
Plain CT scan shows a large subdural hematoma on the left side (long tail arrow), loss of pressure on the basal pool (Figure A, triangular arrow), subsickle hernia formation (Figures B, C, triangular arrows) and left cerebellar curtain incision hernia (Figure C, dotted arrow).

Figure 5

This figure shows the evolution of hemorrhagic parenchymal contusion over time
.
Figures A to C are the tests performed at the time of receiving the patient, and Figures D to F are the follow-up examinations
after 2 hours.
Multiple small bleeding foci may be seen in patients with left orbitofrontal lobes and left anterior temporal lobes
.
On subsequent imaging, the bleeding due to the contusion expanded
.

Figure 6

The patient in this case underwent CT and MRI to evaluate for hemorrhagic substantial contusion
.
The GRE (Figure B) and SWI (Figure C) sequences of MRI show more significant
bleeding contusions (long tail arrows) than a flat-scan CT (Figure A).
In addition, the GRE and SWI sequences can be seen with microbleeding (triangular arrows)
in the white matter of the brain.

Figure 7

This patient with hypertensive cerebral hemorrhage had typical "punctate signs
".

Figure A: A CT scan shows massive cerebral hemorrhage (long tail arrow)
in the right basal ganglion.

Figure B: CTA scan arterial phase shows dotted high-density shadows (long tail arrows), known as "dotted signs"
.
According to the definition of "punctate sign", punctate is a high-density foci
where the hematoma margin is not connected to a blood vessel.

Figure C: The delay period of CTA scan shows a high-density shadow (long tail arrow)
at the same location as Figure B in active bleeding foci.

Figure 8

The CT pan (Figure A), GRE (Figure B), and SWI (Figure C) sequences of the patient in this example showed intraparenchymal hemorrhage (long tail arrow) in the right temporal and occipital lobes
.
The typical manifestation of this bleeding is lobar hemorrhage and is not limited to the blood-supplying area
of the artery.
The patient was eventually diagnosed with cerebral amyloid vascular disease
.

Figure 9

This figure shows a sequence of MRIs in two patients with cerebral amyloid vascular disease
.

Figures A, B: In the FLAIR sequence of the MRI of this patient, the entire white matter region of the brain showed diffuse high-signal abnormalities, that is, microvascular lesions secondary to the starchyl-β peptide deposition in the arterial wall (Figure A, long tail arrow).

In addition, cortical hemorrhage (Figure B, long tail arrows) and microbleeding foci (Figure B, triangular arrows) show an abnormally low signal
.

Figures C and D: In the imaging examination of the second patient, the white matter abnormalities were not as significant as in the previous case (Figure C, long tail arrow), but there were still several microbleeding spots (Figure D, triangular arrows).

Figure 10

The pictures in this group show the imaging examination of 4 patients, and the patients had hemorrhagic transformation after ischemic stroke after undergoing intravascular treatment to complete the revascularization, and the hemorrhagic transformation of these patients belonged to four types: HI-1, HI-2, PH-1, and PH-2
.

Hemorrhagic infarction (HI)

HI-1: small punctate bleeding along the edge of the infarction

HI-2: flaky hemorrhage in the infarction area without mass effect

Parenchymal Hematoma, PH)

Type PH-1: hematoma formation, light mass effect, less than 30% of the infarcted area

PH-2: hematoma exceeds 30% of the infarcted area, has a pronounced mass effect, and bleeding far from the infarcted area

Figure 11

In this case, the patient suffered cerebral infarction in the blood supply area of the left posterior lower cerebellum artery, and developed hemorrhagic transformation, and then underwent posterior cranial fossa decompression surgery
.

Figure A: DWI sequence of MRI shows limited
diffusion of the blood supply area of the left posterior lower cerebellar artery.

Figure B: After 3 days, the patient developed HI-2 type hemorrhagic transformation (long tail arrow), swelling of brain tissue, and disappearance of the fourth ventricle (triangle arrow)
in the cerebral infarction area.

Figure C: After the patient undergoes decompression of the bone flap (long tail arrow), the fourth ventricle (triangular arrow)
can be seen on re-examination.

Figure 12

The patient has the development
of subarachnoid hemorrhage due to rupture of the aneurysm of the anterior communication artery.

Figure A: Plain CT showed extensive high-density shadows in the basal pool, confirming the diagnosis
of subarachnoid hemorrhage.

Figure B: CTA shows a cystic aneurysm (long tail arrow)
at the anterior traffic artery complex.

Figure C: After three-dimensional reconstruction, the aneurysm of the anterior communication artery is clearly visible (long tail arrow).

Figure 13

In this case, imaging of a pediatric patient with intraparenchymal hemorrhage due to rupture of cerebellar arteriovenous malformations
.

Figure A: CT scan shows a high-density shadow of the right frontal lobe, suggesting intraparenchymal hemorrhage (long tail arrow).

Figure B: MIP image of CTA shows a vascular tangle (long tail arrow)
visible along the leading edge of the bleeding foci.

Figure C: DSA examination determines the presence of arteriovenous malformations (long tail arrows) and a small early drainage cortical vein shadow (triangular arrow)
is visible.

Figure 14

This example is intra-brain parenchymal hemorrhage secondary to dural arteriovenous fistula rupture
.

Figure A: A CT scan shows a high density of shadows in the right temporal lobe, suggesting intraparenchymal hemorrhage (long tail arrow).

Figure B: CTA shows that the edges of the bleeding area are covered with cortical veins (long tail arrows
).

Figure C: After injection of contrast from the right external carotid artery, the contrast between the right pterophorophoric sinus visible in the arterial phase is less clear (long tail arrow
.

Figure D: DSA delay phase with further retrograde filling of the right butterfly top sinus (long tail arrow) and cortical vein (triangular arrow) contrast agent
.
This cortical vein corresponds to the vein
shown on CTA.

Figure 15

In women with hypercoagulable status, intraparenchymal hemorrhage secondary to superior sagittal sinus thrombosis
.

CT scan shows multiple intraparenchymal hemorrhage foci (Figure A), and MRI (Figure B to D) further shows low-signal hemorrhagic foci of the parenchyma with peripheral high-signal edema
around the lesion.
In Figures C and D, the filling defect (triangular arrow) within the superior sagittal sinus is a thrombus, which is the cause of intracranial hemorrhage in the
patient.
A filling defect
extending into the right anterior cortical vein may also be seen in Figure D.

Figure 16

In middle-aged women, the main symptom is headache, which is later confirmed to be subarachnoid hemorrhage
secondary to cerebral artery vasculitis.

Figure A: FLAIR imaging of MRI shows an abnormally high signal (long tail arrow)
within the right margin groove.

Figure B: The GRE sequence further confirms the abnormally low signal in the sulcus as subarachnoid hemorrhage (long tail arrow).

Figures C, D: DSA show small beaded changes in the right middle cerebral artery M4 segment (long tail arrow) and the right anterior cerebral artery distal (not shown), consistent
with vasculitis presentation.

Figure 17

This case is subarachnoid hemorrhage
secondary to rupture of a fungal aneurysm of the right middle cerebral artery.

Figures A to C: Both the FLAIR sequence and GRE sequence of MRI confirmed subarachnoid hemorrhage (Figures A and B), and the enhanced scan showed a circular reinforced area of the left central anterior groove along the blood vessel, that is, a fungal aneurysm
.

Figures D~F: DSA shows a lobed fungal aneurysm
located in the left central anterior artery.
This fungal aneurysm is best
shown in a laterally magnified view.