NeuroImages

Figure. (A) Gradient echo (GRE), (B) T2-weighted imaging (diffusion weighted MRI b ⫽ 0) and (C) FLAIR showed right
hemisphere hyperintensity with a slight rim of hypointensity on GRE and T2, consistent with an accumulation of fresh
arterial blood consisting mainly of intact red blood cells containing oxy-Hb. Oxy-Hb is diamagnetic showing hypo or
isointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging (high water content).

Hyperacute post-thrombolysis hematoma
by MRI
A.J. Gagnon, MD, FRCPC, and P.A. Barber, MB ChB, MRCP,
Calgary, Alberta, Canada
An 89-year-old woman presented acutely following the onset of
aphasia and right hemiparesis (NIH Stroke Scale ⫽ 10), without
clinical or CT contraindications to thrombolysis. She received IV
recombinant tissue plasminogen activator (0.9 mg/kg infused over 1
hour after 10% bolus) beginning 90 minutes after symptom onset.

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Address correspondence and reprint requests to Dr. A.J. Gagnon, University of Calgary, Calgary Stroke Program, 1403-29 Street NW, Calgary,
Alberta T2N 2T9, CANADA; e-mail: alexis.gagnon@calgaryhealthregion.ca

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Copyright © 2004 by AAN Enterprises, Inc.

The patient was imaged with a 3 T MRI 2.5 hours after stroke
onset. Ten minutes after the start of the MRI, she suddenly became agitated and developed contralateral left hemiplegia. Fluid
attenuated inversion recovery (FLAIR), T2-weighted and gradient
echo sequences revealed a hyperacute right hemisphere hematoma (figure).1 Microbleeds, a potential risk factor for contralateral symptomatic hemorrhage following thrombolysis, were not
identified on gradient echo sequences.2
1. Parizel PM, Makkat S, Van Miert E et al. Intracranial hemorrhage:
principles of CT and MRI interpretation. Eur Radiol 2001;11:1770 –1783.
2. Kidwell CS, Saver JL, Villablanca P et al. Magnetic resonance imaging
detection of microbleeds before thrombolysis: an emerging application.
Stroke 2002;33:95–98.