Cerebellar haemorrhage

Case contributed by Dr Mark Rodrigues

Presentation

Found slumped in chair, poorly responsive having vomited. Past history of AF (on aspirin), coronary artery disease and Alzheimer's dementia.

Patient Data

Age: 90 years
Gender: Female
CT

Acute right cerebellar haematoma. The haemorrhage extends into the intraventricular system.  There is no subarachnoid haemorrhage.

There is no significant mass effect from the haemorrhage.  There is obstructive hydrocephalus of the lateral and third ventricles.

Mild generalised cerebral volume loss. Moderate periventricular and deep white matter low attenuation in keeping with small vessel change. Chronic right MCA territory infarct (right frontal lobe and insular cortex).

Case Discussion

Right cerebellar haemorrhage causing obstructive hydrocephalus.  Its location and background brain features are in keeping with a "hypertensive" (arteriolosclerosis) haemorrhage.

PATHOLOGY

The patient died 6 weeks after the ICH and underwent post mortem.  This showed an acute left MCA territory infarct and old right cerebellar haemorrhage.

There is severe small vessel disease throughout the white matter with enlarged perivascular spaces and old lacunar infarcts. Beta-amyloid plaques are widely distributed and there is focal cerebral amyloid angiopathy although this is not prominent.

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Case information

rID: 58793
Published: 9th Mar 2018
Last edited: 10th Mar 2018
Inclusion in quiz mode: Included
Institution: University of Edinburgh

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