Lobar intracerebral hemorrhage

Case contributed by Dr Mohamed Mahmoud Elthokapy

Presentation

Acute right-sided hemiplegia and loss of consciousness.

Patient Data

Age: 40 years
Gender: Male

Large hyperdense intracerebral hematoma seen involving the left temporo-occipital region, measuring approximately 8.7 x 3.8 x 4.5 cm (AP x TR x CC) (about 75 cc), with surrounding hypodense edema. Associated positive mass-effect, with effacement of the adjacent cortical sulci, compression of the left lateral ventricle, right-sided midline shift/subfalcine herniation, and probable early left uncal herniation. A swirl sign is noted within the hematoma possibly suggestive of active bleeding and predictive of hematoma expansion.

Further workup including CT cerebral angiography and MRI is recommended to detect the underlying cause.

Case Discussion

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

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