Found slumped in chair, poorly responsive having vomited. Past history of AF (on aspirin), coronary artery disease and Alzheimer's dementia.
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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).
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.
- Charidimou A, Schmitt A, Wilson D, Yakushiji Y, Gregoire SM, Fox Z, Jäger HR, Werring DJ. The Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS): Development and assessment of reliability. (2017) Journal of the neurological sciences. 372: 178-183. doi:10.1016/j.jns.2016.11.021 - Pubmed
- 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