Wk 10, Case 1 - Review

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Report

Patient History
Severe headache over the past several days. History of hypertension, severe migraines.

Findings
These images demonstrate multiple foci of hemosiderin deposition within the white matter of the brain throughout. This includes the posterior fossa, right side of the brainstem, splenium of the corpus callosum. In addition there is a larger area of hemorrhage seen in the right globus pallidus with a minimal amount of surrounding edema.There is extensive white matter high signal intensity in the periventricular region, subcortical regions, as well as in the basal ganglia and striatocapsular region.

Both vertebral arteries, the basilar artery and both carotid arteries are patent. The patient has a partially empty sella, normal variant.Perfusion weighted scans suggests slight hyperperfusion to the left posterior frontal and parietal lobe of uncertain significance.

Impressions
Multiple foci of punctate hemosiderin deposition in the supratentorial and infratentorial compartments as well as an acute 4 mm area of hemorrhage in the right globus pallidus. Findings are suggestive of a hypertensive etiology. The differential diagnosis includes bleeds from a coagulopathy and amyloid angiopathy, the latter less likely due to age.

Moderate chronic small vessel ischemic changes in the white matter and striatocapsular regions bilaterally, greater than expected for age.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 10, Case 1 - Review