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

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.

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
Share article

Article information

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

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Figure 1: Charcot Bouchard aneurysms 
    Drag here to reorder.
  • Drag
    Case 2: with intraventricular extension
    Drag here to reorder.
  • Drag
    NCCT day 0
    Case 1
    Drag here to reorder.
  • Drag
    Case 3
    Drag here to reorder.
  • Drag
    Case 4
    Drag here to reorder.
  • Drag
    Left basal gangli...
    Case 5: hypertensive
    Drag here to reorder.
  • Drag
    Case 6
    Drag here to reorder.
  • Drag
    Case 7
    Drag here to reorder.
  • Drag
    Case 8
    Drag here to reorder.
  • Updating… Please wait.

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.