Basal ganglia haemorrhage

Case contributed by Dr Mark Rodrigues

Presentation

Awoke with right facial weakness, right arm and leg weakness and slurred speech. BAckground AAA repair, COPD and type 2 diabetes

Patient Data

Age: 75 years
Gender: Male
CT

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.

Case Discussion

Deep left intracerebral haemorrhage centred on the external capsule.  Its location and background brain features are in keeping with a "hypertensive" (arteriolosclerosis) haemorrhage.

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PATHOLOGY

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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Case information

rID: 58791
Published: 9th Mar 2018
Last edited: 9th Mar 2018
Inclusion in quiz mode: Included
Institution: University of Edinburgh

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