case_images: PMC9479642_01
case_images: Noncontrast (a) and postcontrast (b) axial computed tomography (CT) show a right thalamic hemorrhage, 16 mm x 19 mm x 21 mm in maximal dimension with ventricular perforation (arrow). On axial gradient-echo T2*-weighted magnetic resonance imaging (T2*WI), microbleeds are identified in the pons (c, arrowheads) and right thalamus (d, arrowhead), ventral to the thalamic hemorrhage (d, arrow). In addition, a small hematoma, 10 mm x 5 mm in dimension, is identified in the left thalamus. It accompanies hyperdense rim on CT that appears as a hypointense rim on T2*WI (a and d, dashed arrow). Postcontrast axial CT does not find spot signs (b, arrow and dashed arrow).
case_images: SNI-13-403-g001.jpg
case_images: PMC9479642_01_SNI-13-403-g001.jpg
case_images: F1
case_images: CT [Figure 1a]. Contrast-enhanced CT revealed no spot signs [Figure 1b]. T2*WI, microbleeds were found in the right thalamus, medulla oblongata, pons, and left temporal [Figures 1c and d]. The rim of the small hematoma found in the left thalamus appeared a hypointense rim on T2*WI [Figure 1d]." This patient was conservatively. managed and eventually transferred to a rehabilitation facility with a modified Rankin scale (mRS) of 2.
case_images: PMC9479642_02
case_images: Noncontrast axial computed tomography (CT) shows a left putaminal hemorrhage, 52 mm x 35 mm x 38 mm in dimension (a, arrow). Postcontrast axial CT does not detect spot signs (b, arrow and dashed arrow). On axial T2*-weighted magnetic resonance imaging (T2*WI), most of the putaminal hemorrhage appears isointense (c, arrow). In addition, a small hematoma, 5 mm x 5 mm in dimension, is identified in the right thalamus with perilesional brain edema. It appears hyperdense on CT, while hypointense on axial T2*WI (a and c, dashed arrow). A microbleed is identified in the right putamen (c, arrowhead).
case_images: SNI-13-403-g002.jpg
case_images: PMC9479642_02_SNI-13-403-g002.jpg
case_images: F2
case_images: CT [Figure 2a]. Contrast-enhanced CT revealed no spot signs [Figure 2b]. In addition, microbleeds were observed in the right putamen [Figure 2c].
case_images: PMC9479642_03
case_images: Noncontrast axial computed tomography (CT) shows a left putaminal hemorrhage, 20 mm x 40 mm x 35 mm in dimension (a, arrow). Postcontrast axial CT does not detect spot signs (b, arrow and dashed arrow). On axial T2*-weighted magnetic resonance imaging (T2*WI), the putaminal hemorrhage appears hypointense in the peripheral parts (c, arrow). In addition, a small hematoma, 8 mm x 8 mm in dimension, is identified in the right putamen with perilesional brain edema. It accompanies a hyperdense rim on CT that appears hypointense rim on axial T2*WI (a and c, dashed arrow).
case_images: SNI-13-403-g003.jpg
case_images: PMC9479642_03_SNI-13-403-g003.jpg
case_images: F3
case_images: CT [Figure 3a]. Contrast-enhanced CT revealed no spot signs [Figure 3b]. Microbleeds were not observed [Figure 3c].
case_images: PMC9479642_04
case_images: Noncontrast axial computed tomography (CT) shows a left thalamic hemorrhage, 19 mm x 30 mm x 25 mm in dimension, in addition to small hematomas, 2 and 8 mm in dimensions in the right thalamus and right cerebellar hemisphere, respectively (a and b, dashed arrow; b, arrow). The small hematomas appear hyperdense on CT, while hypointense on T2*-weighted magnetic resonance imaging (T2*WI) (a-d, dashed arrow). On axial T2*WI, most of the left thalamic hemorrhage appears isointense (d, arrow). In addition, other microbleeds are identified in the right thalamus, left cerebellar hemisphere, and left temporal lobe (c and d, arrowhead).
case_images: SNI-13-403-g004.jpg
case_images: PMC9479642_04_SNI-13-403-g004.jpg
case_images: F4
case_images: CT and hypointense on T2*WI [Figures 4a-c]. Contrast-enhanced CT was not performed due to newly found renal dysfunction. T2*WI, microbleeds were found in the left cerebellar hemisphere, the right thalamus, and the left temporal lobe [Figures 4c and d]. The patient was conservatively managed with spontaneous resolution of the hematomas.