Article Text
Statistics from Altmetric.com
Spontaneous intracranial haemorrhage (ICH) accounts for 10–15% of strokes. The pattern of haemorrhage, together with the patient's age and comorbidities influence the investigation and management.
⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓
- In this window
- In a new window
MRI appearance of parenchymal haematoma
Axial cranial non-contrasted CT scan (A) in a patient with sudden onset left hemiparesis and reduced level of consciousness demonstrates a spontaneous acute right-sided subdural haematoma exerting mass effect with ventricular compression and associated with extensive cortical oedema. The axial reconstruction of a CT angiogram (B) confirms that the cause is a ruptured right bifurcation MCA aneurysm.
Axial non-contrasted CT scans (A–C) demonstrate a haematoma in the right occipital lobe associated with a small right-sided acute subdural haemorrhage. There is compression of the right lateral ventricle and uncal herniation on the right. The sulci are generally effaced. CT angiography performed at the same time (D, axial; E and F—coronal reconstructions) confirm that the cause of the haemorrhage was a vascular malformation, probably a dural arteriovenous fistula with a prominent occipital artery supply. Lateral (F and G) and frontal (H) projections from a right external carotid angiogram confirm the presence of a right-sided arteriovenous dural fistula, supplied by branches of the right occipital and meningeal arteries, draining directly into a dilated cortical vein (almost certainly responsible for the haemorrhage) and then into the right transverse sinus. There is also a supply from dural branches of the right vertebral artery and posterior cerebral artery (see I, lateral projection right vertebral angiogram).
Axial non-contrasted CT scans (A–D) show a left occipital haematoma with oedema and exerting mass effect. There is generalised sulcal effacement, ventricular compression, midline shift and left-sided uncal herniation. CT angiography (E, parasagittal …
Footnotes
-
▸ A separate version of this paper with much more detail is available on the Practical Neurology website (http://pn.bmj.com/).
-
Competing interests None.
-
Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Joanna Wardlaw, Edinburgh, UK.
Linked Articles
- Editors' choice
- Electronic pages
Read the full text or download the PDF:
Other content recommended for you
- Antegrade rheolytic thrombectomy and thrombolysis for superior sagittal sinus thrombosis using burr hole access
- Antegrade rheolytic thrombectomy and thrombolysis for superior sagittal sinus thrombosis using burr hole access
- Endovascular treatment for vaccine-induced cerebral venous sinus thrombosis and thrombocytopenia following ChAdOx1 nCoV-19 vaccination: a report of three cases
- Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow
- Solitaire FR device for treatment of dural sinus thrombosis
- Solitaire FR device for treatment of dural sinus thrombosis
- Combined use of Solitaire FR and Penumbra devices for endovascular treatment of cerebral venous sinus thrombosis in a child
- Combined use of Solitaire FR and Penumbra devices for endovascular treatment of cerebral venous sinus thrombosis in a child
- Management and outcome of spontaneous cerebral venous sinus thrombosis in a 5-year consecutive single-institution cohort
- Embolization strategies for intracranial dural arteriovenous fistulas with an isolated sinus: a single-center experience in 20 patients