Hypertensive intracerebral hemorrhage

Case contributed by Dr Prashant Mudgal

Presentation

Hypertensive male presented with loss of consciousness.

Patient Data

Age: 60
Gender: Male

There is a large hyperdense area of blood attenuation is seen involving the right corona radiata, external capsule, putamen and globus pallidus suggestive of intraparenchymal hemorrhage.

The hematoma is dissecting further into bilateral lateral ventricles, third ventricle, aqueduct and fourth ventricle.

The hemorrhage is surrounded by thin edema and causing mass effect evident by midline shift towards left.

Case Discussion

Nearly two-thirds of intracerebral hemorrhages are located in the basal ganglia. Large hematomas often extend beyond the putamen to include the globus pallidus and internal capsule.

Hematoma dissection (or extension) into the ventricular system occurs in about half the cases of hypertensive ICH and is associated with poor prognosis, particularly when IVH involves the fourth ventricle.

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