Pseudo-porencephaly Mimicking Multiple Intracerebral Hemorrhages.

An 80-year-old female with an unknown medical history developed sudden right hemiparesis and was therefore transferred to our hospital. Neurological examinations revealed right hemiparesis, motor aphasia, and a disturbance of consciousness. Non-contrasted computed tomography (CT) on admission revealed multiple high-density areas, a picture compatible with multiple intracerebral hemorrhages (ICHs) (Picture A and B). However, a CT scan obtained one year previously revealed a basal structural brain abnormality (Picture C and D), which is considered to have played a role in the mimicking multiple ICHs; an inflow hematoma via a ventricular perforation of an ICH in the left frontal subcortex filled the space in the right occipital subcortex and forebrain. A brain CT image obtained 24 hours after onset, demonstrated high-density areas in the right occipital subcortex and the basal forebrain appeared to be less apparent than that in left frontal subcortex (Picture E and F), which indicated the wash out of the hematoma by cerebrospinal fluid (CSF), according to the density changes over time after the formation of the hematoma. Porencephaly is a rare congenital disorder that causes cystic degeneration and encephalomalacia with the formation of porencephalic cysts (1). Organic abnormalities with an acquired etiology, such as stroke, are called “pseudo-porencephaly” (2). In this case, with a medical interview of the patient's family and past radiological images obtained later, a personal history of repeated subcortical cerebral hemorrhages with ventricular perforation due to cerebral amyloid angiopathy, followed by a structural brain abnormality presenting as pseudo-porencephaly was thus revealed.

Picture.

This condition can mimic multiple ICHs by an inflow hematoma filling pseudo-porencephaly via a ventricular perforation.

Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.

The authors state that they have no Conflict of Interest (COI).