Multiple intracerebral hematoma representing a transitional form to chronic encapsulated hematoma: A case report

A case of multiple intracerebral hematoma representing a transitional form to chronic encapsulated hematoma was diagnosed by MR imaging and analyzed microscopically. A 26-year-old man complained of lower left quadrantic hemianopsia on June 17 1996. MR imaging on June 19 revealed a hypointense nodule surrounded by an hyperintense zone on both T1-weighted and T2-weighted images of the right occipital lobe and a small hyperintense lesion on T2-weighted images of the left frontal lobe. The patient experienced a bronchial asthma attack on June 23, followed by sensory disturbance of the right upper limb. CT scanning demonstrated a hematoma in the left frontal lobe. Follow-up MR imaging on July 2 showed the left frontal hematoma as an iso- to hypointense area surrounded by a hyperintense zone on T1-weighted images and as a hypointense area on T2-weighted images. On July 4, the patient suddenly complained of dysarthria. CT scanning showed that the left frontal hematoma had increased in size, and an emergency craniotomy was performed. A tough membrane was found at the bottom of the hematoma cavity. On July 18, craniotomy for the right occipital hematoma was performed. A thick capsule surrounded clots in various stages of organization. Histological examination of the 2 lesions revealed occult vascular malformation within the collagenous tissue. The patient was discharged without any neurological deficit on July 27. To the authors' knowledge, no case of multiple chronic encapsulated hematoma has been reported previously. The pathogenesis and MR imaging findings of chronic encapsulated intracerebral hematoma are discussed.