Basal ganglia haemorrhage
Awoke with right facial weakness, right arm and leg weakness and slurred speech. BAckground AAA repair, COPD and type 2 diabetes
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Left sided acute intracerebral haematoma, with its epicentre in the external capsule. There is a small volume of subarachnoid haemorrhage in the left Sylvian fissure but no intraventricular haemorrhage.
The haematoma and perihaematomal oedema result in partial effacement of the left lateral ventricle and minor midline shift. There is no hydrocephalus.
Moderate generalised cerebral volume loss. Mild periventricular low attenuation in keeping with small vessel change. Multiple chronic infarcts in the basal ganglia, left frontal and right parietal lobes, and the cerebellar hemispheres.
The patient died two days after the ICH and underwent a post mortem. This showed a large haemorrhage centred on the left globus pallidus and external capsule. There is associated subarachnoid haemorrhage. The haemorrhage extends to the cortical surface of the superior temporal gyrus and into the lateral ventricles.
There is extensive small vessel disease throughout the white matter and several old lacunar and cerebellar infarcts. Immunohistochemistry shows no significant amyloid angiopathy.
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- Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. (2010) The Lancet. Neurology. 9 (7): 689-701. doi:10.1016/S1474-4422(10)70104-6 - Pubmed