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Basal ganglia hemorrhage

Case contributed by Mark Rodrigues
Diagnosis certain

Presentation

Awoke with right facial weakness, right arm and leg weakness and slurred speech. BAckground AAA repair, COPD and type 2 diabetes

Patient Data

Age: 75 years
Gender: Male
ct

Left sided acute intracerebral hematoma, with its epicenter in the external capsule. There is a small volume of subarachnoid hemorrhage in the left Sylvian fissure but no intraventricular hemorrhage.

The hematoma and perihaematomal edema result in partial effacement of the left lateral ventricle and minor midline shift. There is no hydrocephalus.

Moderate generalized cerebral volume loss. Mild periventricular low attenuation in keeping with small vessel change. Multiple chronic infarcts in the basal ganglia, left frontal and right parietal lobes, and the cerebellar hemispheres.

Case Discussion

Deep left intracerebral hemorrhage centered on the external capsule.  Its location and background brain features are in keeping with a "hypertensive" (arteriolosclerosis) hemorrhage.

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PATHOLOGY

The patient died two days after the ICH and underwent a post mortem.  This showed a large hemorrhage centered on the left globus pallidus and external capsule. There is associated subarachnoid hemorrhage. The hemorrhage extends to the cortical surface of the superior temporal gyrus and into the lateral ventricles.

There is extensive small vessel disease throughout the white matter and several old lacunar and cerebellar infarcts.  Immunohistochemistry shows no significant amyloid angiopathy.

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