Abstract Details

Title Ultra Hyperacute MR Findings in Reperfusion Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 243

Objective

Background BACKGROUND: GRE sequence is sensitive at detecting the paramagnetic breakdown products of hemoglobin associated with acute ICH. The American Stroke Association allows MR imaging modality to be used to exclude ICH in lieu of CT in the setting of acute ischemic stroke.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: A 75 year old female with a history of paroxysmal atrial fibrillation on aspirin presented with global aphasia, left gaze deviation, and right hemiplegia. She was last seen normal 10 hours prior. National Institutes of Health Stroke Scale was 21. CT brain showed early infarct changes in the left middle cerebral artery (MCA) territory and CT angiogram showed a left M1 occlusion. MRI brain performed 12 hours after presentation showed new hemorrhage that developed during the MRI scan. Gradient echo MRI (GRE) showed an isointense/hyperintense mass without a hypointense rim. MRA head showed recanalization of the left M1 segment. Immediately after MR, clinical deterioration was noted with coma and extensor posturing. CT brain confirmed intracerebral hemorrhage (ICH). The patient progressed to brain death by the next day. In our patient, the cause of the hemorrhage was likely spontaneous recanalization of the left MCA occlusion with subsequent reperfusion hemorrhage. The hemorrhage developed during the course of the MRI study and therefore was only minutes old. The blood in ultra hyperacute ICH consists of intracellular oxygenated hemoglobin that does not have time to deoxygenate, therefore our patient's MRI lacked the expected hypointense signal on GRE.

Conclusions CONCLUSIONS: The clinician should be aware that hypointense signal on GRE typically associated with hyperacute intracerebral hemorrhage may be absent if imaged very early.

Authors/Disclosures
Jordan S. Samuels, MD (Home) PRESENTER	No disclosure on file
	No disclosure on file
James Conners, MD (Rush University Medical Center)	The institution of Dr. Conners has received research support from nih.
Shawna M. Cutting, MD, FAAN	The institution of Dr. Cutting has received research support from Genentech.
Shyam Prabhakaran, MD (University of Chicago)	Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. The institution of Dr. Prabhakaran has received research support from NIH . The institution of Dr. Prabhakaran has received research support from AHRQ. Dr. Prabhakaran has received publishing royalties from a publication relating to health care.
Vivien H. Lee, MD, FAAN (OSU Comprehensive Neurovascular Center)	Dr. Lee has nothing to disclose.
Krzysztof W. Selmaj (University of Warmia and Mazury)	Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.
	No disclosure on file

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