Hypertensive basal ganglial bleed

Case contributed by Frank Gaillard
Diagnosis certain


Acute right hemiparesis.

Patient Data

Age: Elderly
Gender: Male

CT brain (non-contrast)


Non-contrast CT of the brain demonstrates an acute intracerebral hemorrhage centered in the basal ganglia of the left hemisphere. There is extension into the left lateral ventricle (intraventricular hemorrhage), with blood-forming a cast of the lateral ventricle, and passing into the third ventricle. There is no hydrocephalus at this stage. 

Charcot Bouchard aneurysm


This diagram depicts the Charcot Bouchard microaneurysms arising from perforating lenticulostriate arteries. These aneurysms typically arise from arteries no larger than 300 micrometers in diameter. 

Brain section photo credit: 

  • Source: wikimedia commons (file here
  • Author: John A Beal, 2005
  • Permission: This file is licensed under the Creative Commons Attribution 2.5 Generic license (CC-BY).

Superimposed artery diagram: Frank Gaillard, 2012

Case Discussion

This type of bleed is characteristic of a basal ganglia hemorrhage secondary to hypertension. 

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