A chronic encapsulated intracerebral hematoma mimicking a brain tumor: Findings on arterial spin labeling of MRI

Background Intracerebral hematoma usually resolves spontaneously. Chronic encapsulated intracerebral hematoma is rare and mimics a brain tumor. Case description A 50-year-old man had developed intracerebral hematoma in the right temporal lobe. Computed tomography (CT) showed the gradually decreasing density of the hematoma. However, the hematoma did not decrease in size and it showed ring enhancement on contrast-enhanced CT for more than 1 year. Magnetic resonance imaging (MRI) revealed a lesion content showing a high intensity on both T1- and T2-weighted images with ring enhancement. The lesion was diagnosed as a chronic encapsulated intracerebral hematoma developing from an acute hematoma. Arterial spin labeling of MRI showed decreased blood perfusion even in the enhanced capsule, being different from findings of a cystic brain tumor. Conclusion Arterial spin labeling might be a useful modality to distinguish a chronic encapsulated intracerebral hematoma from a cystic hypervascular brain tumor.