Intracerebral haemorrhage with spot sign

Case contributed by Prof Peter Mitchell

Presentation

Acute onset left hemiparesis. "Code stroke".

Patient Data

Age: 90
Gender: Female

Intraparenchymal haemorrhage and surrounding oedema is centered over the RIGHT basal ganglia extending into the frontal and parietal lobes. Intraventricular haemorrhage within the right lateral ventricle, anterior horn of the left ventricle, third ventricle and the aqueduct. Mass-effect is seen with partial compression of the body of the right lateral ventricle and midline shift to the left of 4 mm at the level of the septum pellucidum and effacement of the frontal and parietal sulci. Prominence of the temporal horns in keeping with mild-to-moderate hydrocephalus.

Evidence of previous frontal craniotomy, with metallic clips seen medial to the right frontal lobe and encephalomalacia of the parafalcine frontal lobes. Periventricular and deep white matter hypodensity most likely secondary to chronic small vessel ischaemia.

2 hyperdense foci are seen within the central portion of the intraparenchymal haematoma is seen on the CTA COW. A 3 x 3 mm posteroinferior projecting right PCOM aneurysm is seen.

 

The right basal ganglia haemorrhage has significantly increased in size, now having dimensions of 5.5 x 8.8 x 8.2 centimetres compared to previous dimensions of 4.4 x 4.9 x 4.3 cm. Intraventricular extension into the right lateral, third and fourth ventricles has also mildly progressed.

Progressive mass effect with the previous mild midline shift having increased to 1.5 centimetres at the level of foramina of Monro. There is now complete effacement of the suprasellar cistern, or any aeration and transtentorial descent. No tonsillar herniation.

The degree of hydrocephalus of the trapped left lateral ventricle has increased.

Case Discussion

The "spot sign" is associated with haematoma expansion, and may prove a useful imaging tool to predict those patients who will have clinical deterioration, and may benefit from medical therapies aimed at reducing bleeding risk.

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Case information

rID: 34481
Case created: 23rd Feb 2015
Last edited: 25th Oct 2015
Tag: stroke
Inclusion in quiz mode: Included

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