Presentation
Known young hypertensive since 3 years. Presented with acute onset of left side weakness.
Patient Data
Large T2 hypointense and T1 hyperintense early subacute intraparenchymal hematoma is seen in right temporo-parietal lobe measuring 5.0 x 5.0 x 4.7 cms (AP x TR x CC) with moderate surrounding edema. Mass effect is noted with compression of ipsilateral lateral ventricle & mild dilatation of contralateral lateral ventricle with midline shift of 7.0 mm to left.
There is intraventricular extension of hemorrhage into occipital horn of left lateral ventricle.
Confluent areas of hyperintense signal are seen in bilateral cerebral and cerebellar white matter on T2 & FLAIR sequences - representing chronic small vessel ischemic changes.
Chronic lacunar infarcts are seen in right hemipons, left thalamus and bilateral basal ganglia.
Multiple foci of blooming are seen in bilateral cerebellar hemispheres, bilateral parietal lobes and pons - representing hypertensive microhemorrhages.
Case Discussion
Multiple chronic lacunar infarcts, chronic small vessel ischemic changes in bilateral cerebral hemispheres and multiple microhemorrhages in a known hypertensive patient are consistent with chronic hypertensive encephalopathy.
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