Basal ganglia hemorrhage
Basal ganglia hemorrhage is a common form of intracerebral hemorrhage, and usually as a result of poorly controlled long-standing hypertension. The stigmata of chronic hypertensive encephalopathy are often present (see cerebral microhemorrhages).
Other sites of hypertensive hemorrhages are the pons and the cerebellum. Lobar hemorrhages are also encountered but are more frequently associated with amyloid angiopathy 1.
On this page:
Pathology
Long-standing poorly controlled hypertension accounts for the majority of basal ganglia hemorrhage, 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 hemorrhages 5
- 80% lenticulostriate
- 10% pons
- 10% cerebellum
- found in hypertensive patients
- may thrombose, leak (see cerebral microhemorrhages) 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 an extension into the ventricles, with occasionally the parenchymal component being very small or inapparent.
If there is no ventricular extension, the volume of the hemorrhage may be estimated by ABC/2 and related formulas, which may have neurosurgical and prognostic implications.
MRI
The appearance of hemorrhage on MRI varies with time and to some degree the size of the hematoma (see aging blood on MRI).
Treatment and prognosis
The mainstay of treatment is medical, with control of hypertension and attempts to prevent 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) hemorrhage.
See also
Related Radiopaedia articles
Stroke and intracranial haemorrhage
-
stroke and intracranial hemorrhage
- code stroke CT (an approach)
-
ischemic stroke
- general discussions
- scoring and classification systems
- signs
- by region
- hemispheric infarcts
- frontal lobe infarct
- parietal lobe infarct
- temporal lobe infarct
- occipital lobe infarct
- alexia without agraphia syndrome: PCA
- cortical blindness syndrome (Anton syndrome): top of basilar or bilateral PCA
- Balint syndrome: bilateral PCA
- lacunar infarct
-
thalamic infarct
- Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
- top of the basilar syndrome
- striatocapsular infarct
- cerebellar infarct
-
brainstem infarct
- midbrain infarct
- Benedikt syndrome: PCA
- Claude syndrome: PCA
- Nothnagel syndrome: PCA
- Weber syndrome: PCA
- pontine infarct
- Brissaud-Sicard syndrome
- facial colliculus syndrome
- Gasperini syndrome: basilar artery or AICA
- inferior medial pontine syndrome (Foville syndrome): basilar artery
- lateral pontine syndrome (Marie-Foix syndrome): basilar artery or AICA
- locked-in syndrome: basilar artery
- Millard-Gubler syndrome: basilar artery
- Raymond syndrome: basilar artery
- medullary infarct
- Babinski-Nageotte syndrome
- hemimedullary syndrome (Reinhold syndrome)
- lateral medullary stroke syndrome (Wallenberg syndrome)
- medial medullary syndrome (Déjerine syndrome)
- midbrain infarct
- acute spinal cord ischemia syndrome
- hemispheric infarcts
- by vascular territory
- treatment options
- complications
-
intracranial hemorrhage
-
intra-axial hemorrhage
- signs and formulas
- ABC/2 (volume estimation)
- CTA spot sign
- swirl sign
- by region or type
- signs and formulas
- extra-axial hemorrhage
-
intra-axial hemorrhage
Unable to process the form. Check for errors and try again.