Basal ganglia hemorrhage

Case contributed by Dr Mark Rodrigues

Presentation

Found in the bathroom collapsed and unresponsive. GCS 9 with a dense right sided weakness. Past history of borderline hypertension.

Patient Data

Age: 80 years
Gender: Female
CT

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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Case information

rID: 58789
Published: 9th Mar 2018
Last edited: 9th Mar 2018
Inclusion in quiz mode: Included
Institution: University of Edinburgh

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