Basal ganglia haemorrhage - hypertensive

Case contributed by A.Prof Frank Gaillard

Presentation

New diagnosed uncontrolled hypertension

Patient Data

Age: 40 years
Gender: Male
Modality: CT

There is an acute left-sided corona radiata and internal capsular haemorrhage associated with a small amount of vasogenic oedema. There is no midline shift. Subarachnoid spaces are normal. The fourth ventricle and basal cisterns are not effaced. 

There is conventional aortic arch anatomy noted. The common and internal carotid arteries bilaterally are unremarkable. There is vertebral artery co-dominance noted. No dissection or extracranial stenosis is noted. There is no intracranial aneurysm, vascular malformation or dural fistula. No large branch vascular occlusion or stenosis. 

The perfusion study is unremarkable in the tissues surrounding the haemorrhage. 

CONCLUSION: Basal ganglia haemorrhage. 

Modality: MRI

Intraaxial signal abnormality involving the posterior lentiform nucleus, posterior limb internal capsule, and insula. Signal is heterogeneous - predominantly T2 hyperintense with some intrinsic T1 hyperintensity and blooming on susceptibility sensitive sequences - in keeping with evolving intraparenchymal haematoma. Minor surrounding vasogenic oedema. No associated enhancement.No abnormal susceptibility related signal loss in the lungs. No abnormal intra-axial or meningeal enhancement. No abnormal diffusion restriction. There is a 2.5 millimetre relatively wide necked inferiorly projecting aneurysm of the supraclinoid left internal carotid artery. This is unchanged from the previous CT. No other intracranial aneurysm or vascular abnormality is demonstrated.

Conclusion: Evolving haematoma in the left internal capsule /insula. No abnormal enhancement to suggest underlying mass. 2.5 millimetre aneurysm of the supraclinoid left internal carotid artery.

Case Discussion

This case illustrates typical appearances of a basal ganglia haemorrhage on both CT and MRI. This is most commonly encountered in hypertensive patients, which was the case in this instance. 

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Case Information

rID: 42227
Case created: 12th Jan 2016
Last edited: 12th Oct 2016
Inclusion in quiz mode: Included

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