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Findings: Axial noncontrast enhanced images demonstrate extensive right cerebral intraparenchymal hemorrhage with multiple fluid-blood levels.

Diagnosis: Fluid-blood levels in intracerebral hematoma.

Discussion: Intraparenchymal hematomas can be divided into four stages. Acute (1-3 days), subacute (4-8 days), capsule (9-13 days), and organization (>13 days). CT and MR appearance will vary with time correlating to the break-down products which are present. Computed tomography is generally the first imaging modality obtained to evaluate patients suspected of having intracerebral hemorrhage. A particularly unusual presentation of an intracerebral hemorrhage consists of a fluid-blood level, or even less commonly, multiple fluid-blood levels. It is generally felt that an intracerebral hematoma with even a solitary fluid-blood level should prompt a search for an underlying coagulopathy. One current study states that over half of patients with intracerebral hemorrhages caused by coagulopathies will have characteristic fluid-blood levels. The differential diagnosis for a solitary fluid-blood level would include hemorrhage into a pre-existing cystic lesion.

References:

1. Pleger M. Sensitivity and Specificity of Fluid-Blood Levels for
   Coagulopathy in Acute Intracerebral Hematomas. AJNR Feb 1994; 15:217-223.

2. Zilkha A. Intraparenchymal Fluid-Blood Level: A CT Sign of Recent
   Intracerebral Hemorrhage. J Comput Assit Tomogr 1983; 7:301-305.

3. Haaga, JR. Computed Tomography of the Whole Body, Mosby; 1983:287-289.