Basal ganglia hemorrhage
Updates to Article Attributes
Basal ganglial haemorrhage is a common form of intracerebral haemorrhage, and usually as a result of poorly controlled long standing hypertension. The stigmata of chronic hypertensive encephalopathy are often present (see cerebral microhaemorrhages).
Other sites of hypertensive haemorrhages are the pons, and the cerebellum. Lobar haemorrhages are also encountered but are more frequently associated with amyloid angiopathy 1.
Pathology
Long standing poorly controlled hypertension leads to a variety of pathological changes in the vessels.
- microaneurysms of perforating arteries (Charcot-Bouchard aneurysms)
- small (0.3-0
.9mm.9 mm) diameter aneurysms that occur on small (0.1-0.3mm.3 mm) diameter arteries - distribution that matches incidence of hypertensive haemorrhages 5
- 80% lenticulostriate
- 10% pons
- 10% cerebellum
- found in hypertensive patients
- may thrombose, leak (see cerebral microhaemorrhages) or rupture 2
- small (0.3-0
- accelerated atherosclerosis: affects larger vessels
- hyaline arteriosclerosis
- hyperplastic arteriosclerosis: seen in very elevated and protracted cases
Radiographic features
CT
Typically a region of hyperdensity is demonstrated centered on the basal ganglia or thalamus. Not infrequently there may be extension into the ventricles, with occasionally the parenchymal component being very small or inapparent.
MRI
Appearance of haemorrhage on MRI varies with time and to some degree the size of the haematoma (see ageing blood on MRI).
Treatment and prognosis
The mainstay of treatment is medical, with control of hypertension and attempts to present secondary cerebral injury. If an intraventricular component is present then hydrocephalus is a common sequelae and CSF drainage with an extra-ventricular drain is often needed.
Evacuation of of the clot is controversial and only potentially useful in large (>60ml;60 ml) haemorrhage.
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See also
-<li>small (0.3-0.9mm) diameter aneurysms that occur on small (0.1-0.3mm) diameter arteries</li>- +<li>small (0.3-0.9 mm) diameter aneurysms that occur on small (0.1-0.3 mm) diameter arteries</li>
-</ul><h4>Radiographic features</h4><h5>CT</h5><p>Typically a region of hyperdensity is demonstrated centered on the basal ganglia or thalamus. Not infrequently there may be extension into the ventricles, with occasionally the parenchymal component being very small or inapparent.</p><h5>MRI</h5><p>Appearance of haemorrhage on MRI varies with time and to some degree the size of the haematoma (see <a href="/articles/aging-blood-on-mri">ageing blood on MRI</a>).</p><h4>Treatment and prognosis</h4><p>The mainstay of treatment is medical, with control of hypertension and attempts to present secondary cerebral injury. If an <a href="/articles/intraventricular-haemorrhage">intraventricular</a> component is present then <a href="/articles/obstructive-hydrocephalus">hydrocephalus</a> is a common sequelae and CSF drainage with an extra-ventricular drain is often needed. </p><p>Evacuation of of the clot is controversial and only potentially useful in large (>60ml) haemorrhage.</p><p>{{youtube:http://www.youtube.com/watch?v=d8G7zEXzKRk}}</p><h4>See also</h4><ul>- +</ul><h4>Radiographic features</h4><h5>CT</h5><p>Typically a region of hyperdensity is demonstrated centered on the basal ganglia or thalamus. Not infrequently there may be extension into the ventricles, with occasionally the parenchymal component being very small or inapparent.</p><h5>MRI</h5><p>Appearance of haemorrhage on MRI varies with time and to some degree the size of the haematoma (see <a href="/articles/aging-blood-on-mri">ageing blood on MRI</a>).</p><h4>Treatment and prognosis</h4><p>The mainstay of treatment is medical, with control of hypertension and attempts to present secondary cerebral injury. If an <a href="/articles/intraventricular-haemorrhage">intraventricular</a> component is present then <a href="/articles/obstructive-hydrocephalus">hydrocephalus</a> is a common sequelae and CSF drainage with an extra-ventricular drain is often needed. </p><p>Evacuation of of the clot is controversial and only potentially useful in large (>60 ml) haemorrhage.</p><p>{{youtube:http://www.youtube.com/watch?v=d8G7zEXzKRk}}</p><h4>See also</h4><ul>
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