Choi PM, Ly JV, Srikanth V, et al. Differentiating between Hemorrhagic Infarct and Parenchymal Intracerebral Hemorrhage. Radiol Res Pract. 2012;2012:475497. doi:10.1155/2012/475497

In acute stroke, the differential diagnosis of hemorrhage detected on computed tomography (CT) scan ranges from hemorrhagic infarct (HI), primary intracerebral hemorrhage (ICH) to hemorrhage from venous infarction.

Differentiating HI from ICH can be difficult. Careful examination of the topography of the stroke on the initial CT in different sections may distinguish the two conditions. Signs compatible with an infarct such as dense artery sign and insular ribbon sign should be actively looked for. Advanced imaging technique such as CTA, CTP, and MR imaging may be particularly helpful in difficult cases, looking for perfusion deficit, arterial occlusion, and diffusion restriction remote from the site of hemorrhages. Distinguishing HI from ICH is important given the difference in acute and long term management.

Dr Maxime St-Amant and Dr Aditya Shetty et al.

Hemorrhagic infarct or hemorrhagic transformation of an infarct is seen following breakdown of the lamina of the microvessels.

Intracerebral hemorrhage (ICH) may overlap with a hemorrhagic infarct and hence needs to be differentiated as the line of treatment will vary.

• areas of infarct remote from the site of hemorrhagic infarct

• on perfusion imaging, the center of the hematoma corresponds to highest risk of infarction

• evidence of occlusive disease on TOF imaging

• on perfusion imaging, the region of the deficit does not extend beyond the region of infarct