Dynamics of dotlike hemosiderin spots associated with intracerebral hemorrhage

The authors observed dotlike, low-intensity spots in T2*-weighted magnetic resonance imaging (MRI), subsequently diagnosed histologically as previous microbleeds associated with lipofibrohyalinosis, amyloid angiopathy, and small vessel disease. The nature of dotlike hemosiderin spots (dotHSs), however, is still unknown. This case report seeks to demonstrate the dynamics of dotHSs associated with an intracerebral hematoma (ICH). T2*-weighted MRI of a 72-year-old man with a history of hypertension demonstrated 4 dotHSs 24 months after a left putaminal hemorrhage. Follow-up T2*-weighted MRI 40 months after the acute event demonstrated the asymptomatic formation of 3 more dotHSs, even with good control of blood pressure. Fifty months after the stroke, T2*-weighted MRI showed that 2 of the new dotHSs had become fainter, whereas the hemosiderin associated with the ICH scar remained detectable. To the authors' knowledge, this is the first description of dotHS dynamics associated with ICH.