Basal ganglia hemorrhage - hypertensive

Case contributed by A.Prof Frank Gaillard

Presentation

New diagnosed uncontrolled hypertension

Patient Data

Age: 40 years
Gender: Male

There is an acute left-sided corona radiata and internal capsular hemorrhage associated with a small amount of vasogenic edema. 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 hemorrhage. 

CONCLUSION: Basal ganglia hemorrhage. 

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 hematoma. Minor surrounding vasogenic edema. 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 millimeter 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 hematoma in the left internal capsule /insula. No abnormal enhancement to suggest underlying mass. 2.5 millimeter aneurysm of the supraclinoid left internal carotid artery.

Case Discussion

This case illustrates typical appearances of a basal ganglia hemorrhage 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
Published: 18th Apr 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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