Undergoing rehabilitation post hip fracture. Developed sudden onset dysphasia and right sided weakness. Reduced GCS. Past history of alcohol excess.
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Large deep left sided acute intracerebral haematoma, with its epicentre in the thalamus. The haemorrhage extends into the intraventricular system. There is no subarachnoid haemorrhage.
The haemorrhage displaces and compresses the third ventricle, resulting in obstructive hydrocephalus of the lateral ventricles.
Mild generalised cerebral volume loss. Moderate periventricular low attenuation in keeping with small vessel change.
The patient died 7 days after the ICH and underwent a post mortem. This showed an extensive left sided haemorrhage which is centred in the posterior basal ganglia and thalamus. The haemorrhage extends caudally into the left cerebral peduncle and medially into the lateral ventricle.
There is prominent small vessel disease throughout the white matter plus enlarged perivascular space but no lacunar infarcts. Immunohistochemistry shows no significant amyloid angiopathy.
- Charidimou A, Schmitt A, Wilson D, Yakushiji Y, Gregoire SM, Fox Z, Jäger HR, Werring DJ. The Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS): Development and assessment of reliability. (2017) Journal of the neurological sciences. 372: 178-183. doi:10.1016/j.jns.2016.11.021 - Pubmed
- Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. (2010) The Lancet. Neurology. 9 (7): 689-701. doi:10.1016/S1474-4422(10)70104-6 - Pubmed