Found collapsed. GCS 4. Past history of hypertension, diabetes and previous bowel cancer.
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Acute intracerebral hematoma within the brainstem, with its epicentre 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 of 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.
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.
- Charidimou A, Schmitt A, Wilson D, Yakushiji Y, Gregoire SM, Fox Z, Jäger HR, Werring DJ. The Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS): Development and assessment of reliability. (2017) Journal of the neurological sciences. 372: 178-183. doi:10.1016/j.jns.2016.11.021 - Pubmed
- Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. (2010) The Lancet. Neurology. 9 (7): 689-701. doi:10.1016/S1474-4422(10)70104-6 - Pubmed