Presentation
Found collapsed. GCS 4. Past history of hypertension, diabetes and previous bowel cancer.
Patient Data
Acute intracerebral hematoma within the brainstem, with its epicenter in the pons. The hemorrhage extends into the intraventricular system, and the subarachnoid space (interpeduncular cistern).
There is dilatation of the lateral and third ventricles in keeping with hydrocephalus. Mass effect relating to the hematoma effaces the prepontine cistern.
CT angiogram shows no macrovascular abnormality nor CTA spot sign
Mild generalized cerebral volume loss. Mild periventricular low attenuation in keeping with small vessel change. Chronic lacunar infarct in the left lentiform nucleus/corona radiata.
Case Discussion
Brainstem intracerebral hemorrhage centered on the pons. Its location and background brain features are in keeping with a "hypertensive" (arteriolosclerosis) hemorrhage.
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PATHOLOGY
The patient died 3 days after the ICH and underwent post mortem. This demonstrated a large pontine hemorrhage with extension into the ventricles and subarachnoid spaces.
There is severe small vessel disease throughout the white matter with subcortical micro-infarcts. Immunohistochemistry shows no significant amyloid angiopathy.
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