Hypertensive intracranial haemorrhage

Case contributed by Dr Bruno Di Muzio

Presentation

Patient presenting with left facial droop and left upper and lower limb weakness.

Patient Data

Age: 70-year-old
Gender: Female
CT

CT Brain

There is an intraparenchymal haemorrhage 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 ischaemia. Grey-white matter differentiation is preserved. Ventricular size and sulcal pattern are age appropriate. Basal cisterns are unremarkable. 

MRI

MRI Brain (1 year later)

Within the region of previous right basal ganglia intraparenchymal haemorrhage there is slit-like residual blooming artefact related to haemoglobin 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 ischaemic 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 haemorrhage is highly suggestive to be hypertensive in aetiology. The one-year later MRI demonstrates residual haemoglobin staining in the right basal ganglia with no underlying lesion, making hypertension the favoured aetiology. Also, prominent chronic ischaemic white matter changes were noted. 

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Case information

rID: 56465
Case created: 2nd Nov 2017
Last edited: 4th Nov 2017
Inclusion in quiz mode: Included

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