Basal ganglia haemorrhage

Basal ganglia haemorrhage is a common form of intracerebral haemorrhage, and usually as a result of poorly controlled long-standing hypertension. 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

Long-standing poorly controlled hypertension accounts for the majority of basal ganglia haemorrhage, and leads to a variety of pathological changes in the vessels:

  • microaneurysms of perforating arteries (Charcot-Bouchard aneurysms
    • small (0.3-0.9 mm) diameter aneurysms that occur on small (0.1-0.3 mm) diameter arteries
    • a distribution that matches incidence of hypertensive haemorrhages 5
      • 80% lenticulostriate
      • 10% pons
      • 10% cerebellum
    • found in hypertensive patients
    • 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
CT

Typically a region of hyperdensity is demonstrated centred on the basal ganglia or thalamus. Not infrequently there may be an extension into the ventricles, with occasionally the parenchymal component being very small or inapparent.

MRI

The appearance of haemorrhage on MRI varies with time and to some degree the size of the haematoma (see ageing blood on MRI).

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 the clot is controversial and only potentially useful in large (>60 ml) haemorrhage.


Stroke and intracranial haemorrhage
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Article Information

rID: 6670
Section: Pathology
Synonyms or Alternate Spellings:
  • Basal ganglial haemorrhage
  • Striatocapsular haemorrhage
  • Basal ganglia hemorrhage
  • Basal ganglial hemorrhage

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    Figure 1: Charcot Bouchard aneurysms 
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    NCCT day 0
    Case 1
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    Case 2: with intraventricular extension
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    Case 3
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    Case 4
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    Left basal gangli...
    Case 5: hypertensive
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    Case 6
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    Case 7
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    Case 8
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