In a 50 year old, what is the differential?
Underlying vascular abnormality (AVM, aneurysm), underlying tumour (primary or metastatic). Cerebral amyloid angiopathy certainly can result in lobar haemorrhages but usually it is seen in older patients who have evidence of prior smaller events.
What features should help you suggest the correct diagnosis?
Anterior and posterior to the haematoma are nodular regions of lower attenuation (lower than the thrombus, similar to dural venous sinuses) with a single calcification. These strongly suggest the diagnosis of an arteriovenous malformation (AVM).
Non-contrast CT of the brain demonstrates a large right temporo-parietal haemorrhage. It is associated with moderate midline shift.
Anterior and posterior to the haematoma are nodular regions of lower attenuation (lower than the thrombus, similar to dural venous sinuses) with a single calcification.