Presentation
Found on bedroom floor with marked right sided weakness and right facial droop. Past history of dementia, type 2 diabetes and AF (on aspirin).
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 no hydrocephalus or significant mass effect relating to the hematoma.
Mild generalized cerebral volume loss. Mild periventricular low attenuation in keeping with small vessel change. There are a couple of chronic lacunar infarcts in the basal ganglia
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 4 months after the ICH and underwent post mortem. This showed an old left basal ganglia hemorrhage.
There is severe small vessel disease throughout the cerebral hemispheres with lacunar infarcts, enlarged perivascular spaces and white matter rarefaction. Immunohistochemistry shows parenchymal amyloid deposition in keeping with Alzheimer's pathology but no evidence of amyloid angiopathy.
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