Fat necrosis associated with the use of oral anticoagulant therapy: atypical mammographic findings

Radiol Bras. 2016 Jul/Ago;49(4):267–276 269 http://dx.doi.org/10.1590/0100-3984.2015.0130 left posterior temporal lobe that was distant from the aneurysm and from any subarachnoid cisterns. The case presented here is important because it establishes a mechanism for remote bleeding. In previous reports, a variety of explanations for distant hemorrhage have been proposed, including hypertensive crisis, the formation of jets through subarachnoid cisterns, venous infarction, intraluminal thrombosis, hemorrhagic infarction secondary to vasospasm, and occult vascular anomaly. However, none of those reports provided direct evidence to support any of the proposed mechanisms. In contrast, in our case, we observed definite angiographic evidence of vasospasm in the vessels between the aneurysm and the site of hemorrhage. That constitutes a strong indication that vasospasm-associated hemorrhagic infarction is a mechanism of remote hematoma formation following cerebral aneurysm rupture. In conclusion, we have described a case of ACA aneurysm rupture presenting as remote intraparenchymal hemorrhage in the splenium of the corpus callosum and have demonstrated that vasospasm-induced hemorrhagic infarction is a plausible mechanism for distant bleeding. Neuroradiologists and neurosurgeons should be aware of this rare phenomenon in order to reduce the likelihood of inappropriate treatment.