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Related Concept Videos

Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
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A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...

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Updated: May 18, 2026

Massive Pontine Hemorrhage by Dual Injection of Autologous Blood
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Published on: May 29, 2021

The "Mahjong Sign" in primary pontine hemorrhage.

Marialuisa Zedde1, Rosario Pascarella2

  • 1Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, Reggio Emilia, 42123, Italy. marialuisa.zedde@gmail.com.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|May 16, 2026
PubMed
Summary

A unique brain imaging finding, the "Mahjong sign," was identified in a patient with primary pontine hemorrhage. This sign describes a residual hemorrhagic scar resembling mahjong tiles on follow-up MRI scans.

Keywords:
MRIMahjong signPPHPrimary pontine hemorrhageSWITegmental

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Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Primary pontine hemorrhage (PPH) is a rare type of stroke.
  • Pontine hemorrhages can present with varied clinical symptoms and imaging findings.
  • Identifying specific imaging patterns can aid in diagnosis and understanding of cerebrovascular diseases.

Purpose of the Study:

  • To report a novel imaging finding in a case of unilateral tegmental primary pontine hemorrhage.
  • To introduce and name the
  • Mahjong sign
  • based on its characteristic appearance on follow-up brain MRI.

Main Methods:

  • Case report of a 55-year-old male patient.
  • Follow-up brain Magnetic Resonance Imaging (MRI) was performed.
  • Analysis of the residual hemorrhagic scar morphology within the pontine bundles.

Main Results:

  • A unilateral tegmental primary pontine hemorrhage was diagnosed.
  • Follow-up MRI revealed a distinct residual hemorrhagic scar.
  • The scar's appearance was noted to be similar to the symbols on a mahjong tile, leading to the proposed
  • Mahjong sign
  • .

Conclusions:

  • The
  • Mahjong sign
  • is a newly described imaging pattern associated with primary pontine hemorrhage.
  • This sign, observed on follow-up MRI, represents a residual hemorrhagic scar.
  • Recognition of the
  • Mahjong sign
  • may contribute to the descriptive lexicon of neuroimaging findings in pontine lesions.