case_images: PMC3551500_01
case_images: Axial CT image without intravenous contrast shows a nodular, high attenuation, intraaxial hematoma in the left thalamus and left cerebral peduncle with localized mass effect
case_images: SNI-3-166-g001.jpg
case_images: PMC3551500_01_SNI-3-166-g001.jpg
case_images: F1
case_images: A computed tomography (CT) examination of his head revealed a left thalamic/midbrain "overt" hemorrhage with hydrocephalus [Figure 1].
case_images: (a) Axial T2-weighted MR image shows the lesion to have a slightly irregular rim of low signal surrounding a central zone with mixed high and low signal. A small poorly defined zone of high signal consistent with edema is seen in the adjacent brain tissue, (b) Coronal gradient echo MR image at the same time as a shows a low signal at the site of the hematoma, (c) Axial T2-weighted image 2 months later shows evolutional changes of the intraaxial hematoma with low signal hemosiderin anterior to a high signal cystic-appearing zone. There is decreased mass effect associated with the lesion
case_images: SNI-3-166-g002.jpg
case_images: PMC3551500_01_SNI-3-166-g002.jpg
case_images: F2
case_images: CM [Figures 2a and b]. Conventional cerebral angiography revealed no abnormal findings. Unfortunately, despite improvement on MRI [Figure 2c], he has persistent right-sided hyperthesias, dysesthesias, and allodynia consistent with thalamic pain syndrome, also known as Dejerine - Roussy syndrome.
case_images: (a) Axial CT image without intravenous contrast at the same time as Figure 2c shows a small zone of low attenuation consistent with resolved hematoma and remaining cystic-appearing zone, (b) Axial CT image without intravenous contrast one year after the initial hemorrhage shows a small zone with slightly high attenuation consistent with localized rehemorrhage located anterior to the cystic-appearing zone
case_images: SNI-3-166-g003.jpg
case_images: PMC3551500_01_SNI-3-166-g003.jpg
case_images: F3
case_images: Given his symptoms and CT showing a new slight hyperdensity in the area of his prior bleed the authors suspected he had another small bleed or "ooze" from his suspected cavernoma [Figure 3a and b].