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Paediatric Imaging

Haematoma, intracerebral

a localised collection of blood in the brain parenchyma. The most common cause of intracerebral haematoma is head injury. Cerebral contusion or haematoma is seen in up to 3% of children admitted to hospital with head injury. They may occur in the presence or absence of a skull fracture. A haematoma seen immediately deep to a skull fracture may be caused by brain laceration. This should be suspected particularly if the haematoma has a linear configuration. Haematoma may also occur secondary to haemorrhage following rupture of an arteriovenous malformation or aneurysm (Fig.1). A haematoma may also occur following haemorrhage into an area of contusion or infarction. Coagulopathy increases the potential for intracerebral haematoma to occur. CT is the best means to diagnose intracerebral haematoma acutely. A parenchymal haematoma is seen as a hyperdense mass causing local mass effect. The hyperdensity persists for 10 to 14 days after which it gradually decreases in attenuation and becomes hypodense relative to surrounding brain. Depending on the size of the haematoma it may be replaced by an area of encephalomalacia. Calcification may be present. On MRI the appearance of the haematoma varies with its age. In the hyperacute stage within hours of its development the haematoma it is bright on T1- and dark on T2-weighted sequences secondary to the presence of deoxyhaemoglobin. As the clot resolves the presence of first intracellular methaemoglobin and then extracellular methaemoglobin, followed by haemosiderin determines the signal changes.

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Fig.1

CT scan of the brain showing a focal area of haemorrhage on the left secondary to a ruptured AVM.
Haematoma, intracerebral, Fig.1