Presentation
Sudden onset loss of consciousness. History of hypertension.
Patient Data
Large right frontal lobe intraparenchymal hemorrhage, involving the basal ganglia, and extending throughout the lateral, third and fourth ventricles, and ventricular exit foramina.
Gross ventriculomegaly and transependymal edema is suggestive of associated obstructive hydrocephalus. Prominence of the superior ophthalmic veins is consistent with increased intracranial pressure. Marked leftward midline shift with subfalcine herniation. No transtentorial or descending tonsillar herniation.
Active hemorrhage within the superior aspect of the right frontal lobe likely from a branch of a medial lenticulostriate artery is evident on CT angiogram. Likely corresponding sentinel clot sign on the non-contrast study, evidenced by a small hypodense focus in the region of contrast extravasation on CTA. No aneurysm or vascular malformation evident.
Case Discussion
CT findings of large volume intraparenchymal hemorrhage with extensive intraventricular extension and associated obstructive hydrocephalus. Given the catastrophic nature of the intracranial hemorrhage, the patient was managed with a palliative approach. In this case, hypertension was considered to be the most likely cause for the intraparenchymal hemorrhage.