Presentation
Altered mental status with nausea and vomiting. While en route to hospital via ambulance became unresponsive with agonal respirations.
Patient Data
There is an area of hyperdense parenchymal hemorrhage centered in the right basal ganglia/thalamus with intraventricular extension. Extensive hemorrhage is seen within the fourth ventricle. There is associated severe regional mass effect, with regional basal cisternal effacement and anterior displacement of the brainstem and inferior cerebellar tonsillar herniation.
Case Discussion
This is a classic case for a basal ganglia hemorrhage. Most often caused secondary to poorly-controlled hypertension. There can be extension of hemorrhagic features into the ventricles with hydrocephalus as a sequelae.