Hyperacute intracranial hemorrhage with extensive contrast extravasation and rapid hematoma expansion imaged at onset with magnetic resonance imaging

Evaluation for intracranial hemorrhage is a common indication when performing imaging of the head in the emergency setting. We present a rare case of active, spontaneous extravasation of blood into the brain parenchyma, which evolved during a magnetic resonance imaging examination. A 70-year-old woman who had no previous history of hypertension or trauma underwent magnetic resonance imaging of the brain for confusion and dysarthria. Initial imaging sequences did not demonstrate an acute cerebral hemorrhage; however, subsequent fluid-attenuated inversion recovery, T2- and T1-weighted sequences demonstrated a progressively enlarging signal abnormality. Extravasation of contrast was noted after the administration of gadolinium-based contrast, indicating active intraparenchymal hemorrhage. A computed tomography scan was performed after magnetic resonance imaging to confirm the findings.