Teaching neuroimages: subacute intracerebral hemorrhage mimicking brain tumor.

A 73-year-old man was referred to the outpatient clinic with a 2-week history of headache and apathy. Neurologic examination revealed mild left-sided facial, arm, and leg paresis. Head CT appeared to show a right frontal lobe tumor with finger-like vasogenic edema. Instead, MRI revealed a subacute lobar hemorrhage with perihematomal edema (figure). On follow-up imaging, no underlying cause was found. The temporal changes in density on CT can make a hemorrhage difficult to recognize, particularly in the late subacute phase. MRI is able to detect several phases of hematoma evolution and shows better discrimination of the lesion from surrounding edema.