Presentation
Collapse with sudden onset right sided weakness and slurred speech
Patient Data
Small region of high attenuation centred in the left thalamus extending cranially into the corona radiata, in keeping with an acute haemorrhage. No intraventricular, subdural or subarachnoid extension. Small volume of perihaematomal oedema but no midline shift or hydrocephalus.
Moderate periventricular and deep white matter low attenuation in keeping with small vessel change. Moderate generalised cerebral volume loss.
Slit like region of signal drop out in the left thalamus at the site of previous haemorrhage. No other sites of macro or microbleeds. No superficial siderosis.
Moderate periventricular and deep white matter hyperintensities. Multiple elarged perivascular spaces in the basal ganglia and centrum semiovale. Moderate generalised cerebral volume loss
Case Discussion
Deep left intracerebral haemorrhage centred on the left thalamus. Its location and background brain features are in keeping with a "hypertensive" (arteriolosclerosis) haemorrhage.
The patient underwent a post-mortem which showed an old left thalamic haematoma. There was extensive small vessel disease with enlarged perivascular spaces, white matter rarefaction, and small lacunar infartcs. There was no significant amyloid angiopathy.
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