Basal ganglia haemorrhage

Case contributed by Dr Mark Rodrigues

Presentation

Headache.

Patient Data

Age: 75 years
Gender: Male
CT

Small focus of increased attenuation in the posterior left head of caudate in keeping with an acute haemorrhage. There is no perihaematomal oedema or mass effect. No intraventricular, subarachnoid or subdural extension.

Symmetrical high attenuation in both basal ganglia (visible on both brain and bone windows) in keeping with calcification.

Mild generalised cerebral volume loss. No periventricular low attenuation or lacunar infarcts.

 

MRI

On the blood-sensitive sequences there is signal drop-out in the left head of caudate corresponding to the site of previous haemorrhage. A microbleed is present in the right external capsule. No other macro- or microhaemorrhages. No superficial siderosis

There are dilated perivascular spaces within the basal ganglia visible on T2-weighted imaging. Mild periventricular and brainstem hyperintensities are seen, in-keeping with small vessel disease.

Case Discussion

Deep left intracerebral haemorrhage centred on the left caudate head. Its location and background brain features (deep microbleed, white matter hyperintensities and enlarged deep perivascular spaces) are in keeping with a "hypertensive" (arteriolosclerosis) haemorrhage.

Incidental bilateral basal ganglia calcification resulting in very high attenuation on CT.

The patient underwent post-mortem which showed a left caudate nucleus haematoma and severe small vessel disease throughout the white matter. There was no cerebral amyloid angiopathy on immunohistochemistry.

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Case information

rID: 58346
Published: 13th Feb 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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