Presentation
Headache.
Patient Data
Small focus of increased attenuation in the posterior left head of caudate in keeping with an acute hemorrhage. There is no perihaematomal edema 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 generalized cerebral volume loss. No periventricular low attenuation or lacunar infarcts.
On the blood-sensitive sequences there is signal drop-out in the left head of caudate corresponding to the site of previous hemorrhage. A microbleed is present in the right external capsule. No other macro- or microhemorrhages. 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 hemorrhage centered 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) hemorrhage.
Incidental bilateral basal ganglia calcification resulting in very high attenuation on CT.
The patient underwent post-mortem which showed a left caudate nucleus hematoma and severe small vessel disease throughout the white matter. There was no cerebral amyloid angiopathy on immunohistochemistry.
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