Hypertensive intracerebral hemorrhage

Case contributed by Dr Antonio Rodrigues de Aguiar Neto

Presentation

The patient has arterial hypertension, complaining of vertigo, and imbalance.

Patient Data

Age: 50 years
Gender: Male

Axial non-contrast CT of the brain shows an acute intracerebral hemorrhage centered in the thalamus of the left hemisphere. There is a hypodense rim around the hematoma, which represents edema.

There are two sequelae of lacunar infarcts in the right nucleocapsular region.

Acute left thalamic hematoma, which measures 1.9 x 2.4 x 2.9 cm, with a volume of 6.8 cc. The blood demonstrates the central isointense signal and peripheral hyperintensity on T1W images, indicating methemoglobin, which represents the early subacute phase. There is associated hypointense T2* rim from hemosiderin and ferritin deposition. The small edema surrounding the hematoma exhibits high signals in the T2W. There is no intraventricular hemorrhage or hydrocephalus.

Case Discussion

Uncontrolled hypertension is the most common etiology of spontaneous intracerebral hemorrhages in elderly patients 1,2,3, which is a neurologic emergency with high mortality rates 1,2,3. Hypertensive intracerebral hemorrhages usually occur in the following locations: basal ganglia, thalamus, pons and cerebellum 1,2,3.

Blood has a characteristic appearance on MRI at acute, subacute and chronic stages. This case illustrates the typical features of an early subacute thalamic hemorrhage secondary to hypertension. 

Case courtesy

  • Sterfferson Morais, MD - PGY-3, Radiology Resident, Department of Radiology
  • Antonio Rodrigues de Aguiar Neto, MD - Radiologist, Department of Radiology
  •  Hospital da Restauração – Recife, PE – Brazil

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