Organized intracerebral hematoma with acute hemorrhage: CT patterns and pathologic correlations

Five cases of pathologically proven organized intracerebral hematoma with recent hemorrhage are reported. The hemorrhages were spontaneous, were located in deep structures of the brain, and presented without a clinical history of hypertension or trauma. No underlying causes of the hematomas were identified histologically. Various computed tomographic (CT) patterns of recurrent hemorrhage in an organized hematoma were observed. A hyperdense, well demarcated mass with minimal contrast enhancement but no surrounding edema was observed when rehemorrhage was confined within a late-organizing hematoma. A "target" sign of a ring-enhancing mass was observed when the new hemorrhage developed within an early-organizing hematoma. When a new hemorrhage occurred outside a solid-enhancing organized hematoma, the CT appearance suggested a possible tumoral hemorrhage. Close clinical and CT follow-up is desirable for initial management of a suspicious rehemorrhaging organized hematoma situated in the deep-seated or superficial sensitive structures if the symptomatology has stabilized or improved. Tissue diagnosis and surgical evacuation are indicated when the clinical course fluctuates or progresses and CT demonstrates an interval increase of lesion.