Presentation
Patient presenting with left facial droop and left upper and lower limb weakness.
Patient Data
There is an intraparenchymal hemorrhage is noted at the posterior aspect of the lentiform nucleus, extending superiorly into the centrum semiovale and medially into the posterior limb of the right internal capsule. No midline shift, transtentorial or tonsillar herniation at time of scanning. Bilateral periventricular white matter hypoattenuation is most likely in keeping with chronic small vessel ischemia. Grey-white matter differentiation is preserved. Ventricular size and sulcal pattern are age appropriate. Basal cisterns are unremarkable.
Within the region of previous right basal ganglia intraparenchymal hemorrhage there is slit-like residual blooming artefact related to hemoglobin staining, but no underlying mass lesion. There is no abnormal contrast enhancement. The white matter demonstrates multiple somewhat confluent FLAIR hyperintensities suggestive of chronic small vessel ischemic changes, which are in an amount much over the expected for the patients age group. No features to suggest amyloid angiopathy. The ventricles and basal cisterns appear unremarkable.
Case Discussion
This patient has a long history of systemic arterial hypertension, given its location, the basal ganglia hemorrhage is highly suggestive to be hypertensive in etiology. The one-year later MRI demonstrates residual hemoglobin staining in the right basal ganglia with no underlying lesion, making hypertension the favored etiology. Also, prominent chronic ischemic white matter changes were noted.
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