Presentation
Found in the bathroom collapsed and unresponsive. GCS 9 with a dense right sided weakness. Past history of borderline hypertension.
Patient Data
Left sided acute intracerebral hematoma, with its epicenter in the basal ganglia/external capsule. The hemorrhage extends into the intraventricular system. There is no subarachnoid hemorrhage.
There is partial effacement of the left lateral ventricle but no hydrocephalus or significant midline shift.
Mild generalized cerebral volume loss. Mild periventricular low attenuation in keeping with small vessel change.
Case Discussion
Deep left intracerebral hemorrhage centered on the basal ganglia/external capsule. Its location and background brain features are in keeping with a "hypertensive" (arteriolosclerosis) hemorrhage.
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PATHOLOGY
The patient died 9 months after the ICH and underwent a post mortem. This showed an old hematoma in the left basal ganglia, extending to the insular cortex laterally and lateral ventricle medially.
There is severe small vessel disease throughout the cerebral hemispheres. Immunohistochemistry shows only occasional meningeal and parenchymal amyloid angiopathy.
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