Presentation
Found in bed with dense left sided weakness
Patient Data
High attenuation centered on the right thalamus consistent with an acute hemorrhage. There is hemorrhage extension into the ventricular system. No subarachnoid or subdural hemorrhage.
The hematoma and perilesional edema result in compression and midline shift of the 3rd ventricle. The temporal horns of the lateral ventricles appear dilated in keeping with early hydrocephalus.
Marked periventicular and deep white matter low attenuation in keeping with severe small vessel disease. Mild generalized cerebral volume loss.
Rounded region of signal drop out on GRE. The mass effect demonstrated on the diagnostic CT has reduced, consisting with resolving right thalamic hematoma.
Several mixed lobar and deep microbleeds are present. Some prominent vessels in the basal ganlgia also result in focal areas of signal drop out. There may be an old hemorrhage at this site (left thalamus).
Severe periventricular and deep white matter hyperintensities, in keeping with small vessel disease. Small chronic cortical infarct in the right frontal lobe (MCA territory). Enlarged basal ganglia and centrum semiovale enlarged perivascular spaces. Mild to moderate generalized cerebral volume loss.
Case Discussion
Deep right intracerebral hemorrhage centered on the right thalamus. Its location and background brain features (white matter hyperintensities, enlarged deep perivascular spaces and mixed lobar and deep microbleeds) are in keeping with a "hypertensive" (arteriolosclerosis) hemorrhage.
There is extension into the ventricular system and evidence of early hydrocephalus on the diagnostic CT.
The patient underwent a post-mortem which showed an old right-sided thalamic hematoma, with severe small vessel disease. Immunohistochemistry showed very limited cerebral amyloid angiopathy in the parietal cortex only.
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