Presentation
Seizures and reduced consciousness
Patient Data
Large lobar intracerebral haematoma involving the right frontal and parietal lobes with surrounding perihaematomal oedema. Localised subarachnoid haemorrhage. No intraventricular haemorrhage.
There is effacement of the right lateral ventricle, marked leftward midline shift, right uncal herniation and effacement of the basal cisterns. Dilated left trigone and temporal horn in keeping with hydrocephalus.
Ovoid, partially calcified lesion immediately inferior to the haematoma in keeping with a giant aneurysm.
No evidence of small vessel disease.
Partially thrombosed giant right middle cerebral artery aneurysm lying immediately inferior to the parenchymal haematoma. There is reduced opacification of the right middle cerebral artery branches distal to the aneurysm compared with the left side.
7 mm left middle cerebral artery trifurcation aneurysm.
Case Discussion
- Macrovascular lesions, such as arterial aneurysms, underlie 10-15% of spontaneous intracerebral haemorrhage.
- Early identification of such abnormalities is important to allow appropriate treatment.
- Specific features on non contrast CT of an underlying macrovascular lesion include enlarged vessels or calcifications along margins of ICH 1.
- Younger age (< 50 years) and ICH location adjacent to the circle of Willis are other risk factors for an underlying macrovascular lesion.
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