Lobar haemorrhage

Case contributed by A.Prof Frank Gaillard

Presentation

Sudden deterioration in conscious state.

Patient Data

Age: 60 years
Modality: CT

CT without contrast demonstrates a very large lobar haemorrhage occupying most of the frontal lobe and extending into the ventricles. It exerts marked positive mass effect. 

On the left there is evidence of a previous infarct. 

The patient went onto have the clot evacuated and a small sample of tissue sent to histology. 

Histology

Sections  show  abundant  fresh  blood clot,  containing   layers of degenerating   neutrophils  and  fibrin  alternating  with  red  cells. There is accumulation of  blood beneath the leptomeninges, which contain scattered vessels of varying  calibre showing mural thickening with some luminal narrowing, and amorphous eosinophilic material within the wall that is strongly  suggestive of amyloid.   Congo red  stains this material, which shows apple green birefringence on polarisation.  

A small fragment  of oedematous cortex and white matter  is sampled. This  shows a mild  astrocytosis.  Only small capillary-sized vessels  are seen, however  these are normal in  appearance. There is no evidence of a vascular malformation.

FINAL DIAGNOSIS: Intracerebral  haematoma,  cortex over  frontal cerebral haematoma and leptomeningeal vessels showing amyloid angiopathy.

Case Discussion

Lobar haemorrhages are typically seen in elderly patients and in most cases attributable to cerebral amyloid angiopathy. In a young patients a lobar haemorrhage should be viewed with suspicion and an underlying lesion sought. 

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Case Information

rID: 10678
Case created: 5th Sep 2010
Last edited: 7th Jan 2016
Inclusion in quiz mode: Included

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