Case of the month

July 1, 2008 Diagnostic Imaging. Case of the month -------------------------------------------------------------------------------- CLINICAL HISTORY A 39-year-old man with a history of cocaine use presented with acute left hemiparesis. FINDINGS Initial noncontrast CT revealed an acute hemorrhage centered in the posterior right putamen (Figure 1). A CT angiogram was performed to exclude an underlying vascular lesion and to predict potential expansion of the hematoma. No underlying lesion was seen, but a focal area of increased density consistent with active extravasation was identified on the contrast-enhanced CT (Figure 2). A subsequent noncontrast CT, performed six hours later, demonstrated significant enlargement of the hematoma (Figure 3).

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