Presentation
Found unresponsive having vomited. GCS 3. Past history of hypertension and TIAs
Patient Data
Acute right cerebellar hematoma. The hemorrhage extends into the intraventricular system and subarachnoid space.
The hemorrhage displaces the fourth ventricle and cerebral aqueduct, and there is obstructive hydrocephalus of the lateral and third ventricles.
Mild generalized cerebral volume loss. Severe periventricular and deep white matter low attenuation in keeping with small vessel change.
Case Discussion
Right cerebellar hemorrhage causing obstructive hydrocephalus. Its location and background brain features are in keeping with a "hypertensive" (arteriolosclerosis) hemorrhage.
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PATHOLOGY
The patient died 5 days after the ICH and underwent a post mortem. This showed a large right cerebellar hemorrhage with ventricular and subarachnoid extension and hydrocephalus.
Small vessel disease extends throughout the white matter although there are no lacunar infarcts. Immunohistochemistry shows extensive amyloid angiopathy, although this is less prominent in the cerebellum compared with the frontal, temporal and parietal regions.
The appearances are more in keeping with a primary hypertensive hemorrhage on a background of small vessel disease, rather than a cerebral amyloid angiopathy associated hemorrhage.
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