On non-contrast CT, what finding most strongly suggests an acute intracerebral hemorrhage?

On non-contrast CT, what finding most strongly suggests an acute intracerebral hemorrhage?

• A. Hypodense region within the brain parenchyma.
• B. Calcified lesion.
• C. Hyperdense region within the brain parenchyma.
• D. Hyperdense ventricular lining.

Answer: (C)

Fresh blood on a non-contrast CT is bright compared with surrounding brain tissue because it has a higher density, making the hematoma appear hyperdense. This parenchymal hyperdensity is the strongest clue that an intracerebral hemorrhage is acute, typically visible within minutes to hours after symptom onset. As time passes, the blood products break down and the lesion can become isodense or hypodense, so the hyperdense appearance is most characteristic of the very early phase. In contrast, a hypodense area in the brain parenchyma often points to edema or early ischemia, not acute bleeding. Calcified lesions reflect chronic changes, not a fresh bleed. Hyperdensity along the ventricular lining could indicate intraventricular blood or calcification, but it does not specifically signify an intracerebral hemorrhage within the brain tissue itself.

Fresh blood on a non-contrast CT is bright compared with surrounding brain tissue because it has a higher density, making the hematoma appear hyperdense. This parenchymal hyperdensity is the strongest clue that an intracerebral hemorrhage is acute, typically visible within minutes to hours after symptom onset. As time passes, the blood products break down and the lesion can become isodense or hypodense, so the hyperdense appearance is most characteristic of the very early phase.

In contrast, a hypodense area in the brain parenchyma often points to edema or early ischemia, not acute bleeding. Calcified lesions reflect chronic changes, not a fresh bleed. Hyperdensity along the ventricular lining could indicate intraventricular blood or calcification, but it does not specifically signify an intracerebral hemorrhage within the brain tissue itself.