chronic bleed appears hypodense on CT, so is there any way to differentiate between chronic intraparenchymal hemorrhage and infarct? As they both appear hypodense on CT
a chronic bleed and Infarct both would look hypodense. But A Chronic bleed - would be reorbed from the parenchyma pver time and result in gliosis. This gliotic area is like an empty space in the brain and will be filled up with CSF. As a portion of the brain parenchyma has shrunkene due to gliosis - the adjacent ventrcles / sulci will dilate - this is called as ex-vacuo dilatation. Whereas an Acute infacrt is hypodense as the affected brain parenchyma is edematous and swollen. So this edematous affected brain will infact cause mass effect and compression of adjacent ventricles / sulci - the opposite of what will happen with chronic bleed / gliosis