Q: Why does the time of onset matter here? show answer
Q: How will we manage this presentation? show answer
Acute right sided weakness. Presented to ED within 2 hours of the onset of weakness.
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Hyperdense left basal ganglia with surrounding oedema and mild mass effect. Layering of dense material in both ventricles.
Consistent with acute intracerebral haemorrhage.
This is a case of a haemorrhagic stroke in the left basal ganglia.
This area of the brain is especiailly at risk in hypertensive haemorrhage due to the high vascular supply and the stress placed on the vessels here.
These findings are one of the main indications for prompt CT imaging in suspected strokes as if this patient was given thrombolysis or high dose aspirin it would make the whole case worse.
Most of the management is focussed on blood pressure control, managing any further complications and stroke rehabilitation.
Thanks to Dr Mohammad Taghi Niknejad for orginally uploading this case. The original can be viewed here.
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