Hypertensive hemorrhage with microhemorrhages

Case contributed by A.Prof Frank Gaillard

Presentation

Headache and ataxia.

Patient Data

Age: 55 years
Gender: Male

A hematoma in the left cerebellar hemisphere is present with mild mass effect on the vermis and fourth ventricle, with no hydrocephalus. 

There is patchy subcortical white matter hypodensity in both frontal lobes near the vertex out of keeping for age. No extra-axial collection. Muscles demonstrate no abnormal density and minimal atherosclerotic calcification.

MRI

MRI months later

Multiple foci of high T2 signal in the supratentorial white matter is in keeping with chronic small vessel ischemia. The residual left cerebellar hematoma is characterized as a blooming area of signal loss with the expected volume loss. 

There are multiple scattered small foci of blooming signal loss (microhemorrhages) particularly on the pons, cerebellar hemispheres and basal ganglia. 

The increased T2 signal in the right inferior olivary nucleus probably represents early hypertrophic olivary degeneration

Conclusion: Findings are in keeping with chronic small vessel disease and hypertensive microangiopathy. 

Case Discussion

Typical location and appearances of a hypertensive hemorrhage, with microhemorrhages in the same distribution as macrohemorrhages. 

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Case information

rID: 39189
Published: 15th May 2017
Last edited: 15th May 2017
Inclusion in quiz mode: Included

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