Abstract
A 53-year-old right handed man with hypertension developed stepwise deterioration in memory and calculation associated with right hemiparesis and small steppage gait in the last 7 years. On admission the blood pressure was 170/100 mmHg and neurological examinations revealed left facial and hypoglossal palsy, increased jaw jerk, and impaired memory, abstraction, constraction and calculation. A CT scan showed hypodensity areas, in bilateral basal ganglia, white matter of the left parietal cortex and the left cerebellar hemisphere. In these regions and in the anterior portion of the left thalamus as well, high field magnetic resonance (MR) with T2-weighted images demonstrated hyperintensity areas surrounded by hypointensity rims, indicating old cerebral hemorrhages. Dementia in this case seemed to be due to, multiple cerebral hemorrhage with hypometabolic areas in the hemorrhage sites and in bilateral frontal lobe. MR is useful to differentiate old cerebral hemorrhage from infarction in those with multiple hypodensity areas on CT scan.
