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