Pediatric Intracerebral Hemorrhage

  • Etiology: Trauma, anticoagulation, aneurysm, vascular malformation, vasculitis
  • Imaging:
    — Blood within cerebral parenchyma
    — Look for findings of increased intracranial pressure including herniation
  • Note: If etiology is uncertain perform MRI and MRA or CTA to look for vascular causes
  • DDX:
  • Complications: Herniation
  • Treatment: Evacuation of clot
  • Clinical:

Imaging evolution of intracerebral hemorrhage evolution on MRI: (Note that this is most commonly used to date subdural hematomas)

AgeStateT1WIT2WI
< 1 dayOxyHbIsoBrightHyperacute
1-3 daysDeOxyHbIsoDarkAcute
3-7 daysIntracellularMetHbBrightDarkEarly Subacute
1-3 weeksExtracellularMetHbBrightBrightLate Subacute
> 3 weeksHemosiderinDarkDarkChronic

Radiology Cases of Intracerebral Hemorrhage

Radiology Cases of Intracerebral Hemorrhage Due To Extracorporeal Membrane Oxygenation

US of intracerebral hemorrhage in a patient on extracorporeal membrane oxygenation (ECMO)
Coronal and sagittal US of the brain shows a large, round echogenic lesion in the left parietal lobe.
US of intracerebral hemorrhage due to extracorporeal membrane oxygenation
CXR AP (above) shows the tip of the nasogastric tube in the left hemithorax. The punctate radiopaque tip of the arterial ECMO catheter projects near the aortic arch. The punctate radiopaque tip of the venous ECMO catheter projects in the right atrium. The endotracheal tube tip projects between the clavicles and the carina.

Coronal (below left) and sagittal (below right) US of the brain shows a round well-circumscribed echogenic lesion adjacent and inferior to the posterior horn of the right lateral ventricle.
CT of intracerebral hemorrhage in a patient on extracorporeal membrane oxygenation (ECMO)
Sagittal, coronal and axial CT without contrast of the brain shows a large, round high density lesion in the right parietal lobe.