Basal ganglial haemorrhage
A basal ganglial haemorrhage is a common form of intracerebral haemorrhage, usually as a result of poorly controlled long standing hypertension, and the stigmata of chronic hypertensive encephalopathy are often present (see cerebral microhaemorrhages).
Other sites of hypertensive haemorrhages are the pons, and the cerebellum. Lobar haemorrhages are also encountered but are more frequently associated with amyloid angiopathy 1.
Pathology
Long standing poorly controlled hypertension leads to a variety of pathological changes in the vessels.
- microaneurysms of perforating arteries : (Charcot-Bouchard aneurysms) are small (0.3 - 0.9mm) diameter occurring on small (0.1 - 0.3mm) diameter arteries in a distribution which matches incidence of hypertensive haemorrhages and are found in hypertensive patients. They may thrombose, leak (see cerebral microhaemorrhages) or rupture 2
- accelerated atherosclerosis : affects larger vessels
- hyaline arteriosclerosis
- hyperplastic arteriosclerosis: seen in very elevated and protracted cases
Radiographic features
CT
Typically a region of hyperdensity is demonstrated centered on the basal ganglia or thalamus. Not infrequently there may be extension into the ventricles (see case 2), with occasionally the parenchymal component being very small or inapparent.
MRI
Appearance of haemorrhage on MRI varies with time and to some degree the size of the haematoma (see ageing blood on MRI)
Treatment
The mainstay of treatment is medical, with control of hypertension and attempts to present secondary cerebral injury. If an intraventricular component is present then hydrocephalus is a common sequelae and CSF drainage with an extra-ventricular drain is often needed.
Evacuation of of the clot is controversial and only potentially useful in large (>60ml) haemorrhage.
