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Packard et al¹ report a case of intracerebral hemorrhage with negative results on a computed tomographic (CT) scan. Although the CT scans pictured in the article do not show the typical hyperdensity of acute hemorrhage, a close examination of images D and I reveals that the results are not in fact "negative." In both CT scans, the area corresponding to the hemorrhage on the magnetic resonance image shows obliteration of the sulci, indicating the presence of mass effect as would be expected for an acute hemorrhage. Such an isodense appearance is by no means unusual in subdural hematoma, and one can certainly imagine that the combined radiodensity of brain tissue and blood products in an intracerebral hemorrhage might fortuitously appear similar to gray matter.

Consequently, I believe that the authors' conclusion that CT is not sufficiently sensitive to exclude intracerebral hemorrhage is unwarranted. A close examination of CT scans followed . . . [Full Text of this Article]

Stephen S. Kamin, MD
Newark, NJ