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Dynamics of dotlike hemosiderin spots associated with intracerebral hemorrhage
Toshio Imaizumi1, Masahiko Chiba, Toshimi Honma
1Department of Neurosurgery, Hakodate Municipal Hospital, 1-10-1 Minato-cho, Hakodate 041-0821, Hokkaido, Japan. timaizum@d9.dion.ne.jp
Abstract:
The authors observed dotlike, low-intensity spots in T2*-weighted magnetic resonance imaging (MRI), subsequently diagnosed histologically as previous microbleeds associated with lipofibrohyalinosis, amyloid angiopathy, and small vessel disease. The nature of dotlike hemosiderin spots (dotHSs), however, is still unknown. This case report seeks to demonstrate the dynamics of dotHSs associated with an intracerebral hematoma (ICH). T2*-weighted MRI of a 72-year-old man with a history of hypertension demonstrated 4 dotHSs 24 months after a left putaminal hemorrhage. Follow-up T2*-weighted MRI 40 months after the acute event demonstrated the asymptomatic formation of 3 more dotHSs, even with good control of blood pressure. Fifty months after the stroke, T2*-weighted MRI showed that 2 of the new dotHSs had become fainter, whereas the hemosiderin associated with the ICH scar remained detectable. To the authors' knowledge, this is the first description of dotHS dynamics associated with ICH.
Insights
This case report details the dynamic changes of dotlike hemosiderin spots (dotHSs) following an intracerebral hemorrhage. These previously unknown spots can form and fade over time, offering new insights into small vessel disease progression.
Area of Science:
- Neurology
- Neuroradiology
- Pathology
Background:
- Dotlike hemosiderin spots (dotHSs) are low-intensity T2*-weighted MRI findings.
- Their exact nature and evolution, particularly after intracerebral hemorrhage (ICH), remain unclear.
Observation:
- A case report tracked dotHSs in a 72-year-old male hypertensive patient post-ICH.
- Serial T2*-weighted MRI scans revealed the asymptomatic formation of new dotHSs over 40 months.
- Further imaging at 50 months showed some new dotHSs fading, while the ICH scar remained visible.
Findings:
- This study presents the first observed dynamics of dotHSs in relation to an intracerebral hematoma.
- New dotHSs can emerge and change in intensity years after an initial hemorrhage, irrespective of blood pressure control.
Implications:
- Understanding dotHS dynamics may enhance the diagnosis and monitoring of small vessel diseases.
- This highlights the potential for ongoing microvascular changes even after ICH and with managed hypertension.