Presentation
Found slumped in chair, poorly responsive having vomited. Past history of AF (on aspirin), coronary artery disease and Alzheimer's dementia.
Patient Data
Acute right cerebellar hematoma. The hemorrhage extends into the intraventricular system. There is no subarachnoid hemorrhage.
There is no significant mass effect from the hemorrhage. There is obstructive hydrocephalus of the lateral and third ventricles.
Mild generalized cerebral volume loss. Moderate periventricular and deep white matter low attenuation in keeping with small vessel change. Chronic right MCA territory infarct (right frontal lobe and insular cortex).
Case Discussion
Right cerebellar hemorrhage causing obstructive hydrocephalus. Its location and background brain features are in keeping with a "hypertensive" (arteriolosclerosis) hemorrhage.
PATHOLOGY
The patient died 6 weeks after the ICH and underwent post mortem. This showed an acute left MCA territory infarct and old right cerebellar hemorrhage.
There is severe small vessel disease throughout the white matter with enlarged perivascular spaces and old lacunar infarcts. Beta-amyloid plaques are widely distributed and there is focal cerebral amyloid angiopathy although this is not prominent.
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