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basal_ganglia_hemorrhage

Basal ganglia hemorrhage

see also Putaminal hemorrhage.

see Bilateral basal ganglia hemorrhage.

Epidemiology

Basal ganglia hemorrhage is a common form of intracerebral hemorrhage

Etiology

Usually as a result of poorly controlled long standing hypertension.

It is probably not a factor in at least 35 % of basal ganglion hemorrhages.

The stigmata of chronic hypertensive encephalopathy are often present.

Most of the cases are spontaneous unilateral hemorrhage, and the volume of blood is usually < 30 cc 1).

Traumatic basal ganglia hematomas (TBGHs) are uncommon events in patients with closed head injuries.

Pathology

Long standing poorly controlled hypertension leads to a variety of pathological changes in the vessels.

microaneurysms of perforating arteries (Microaneurysms of Charcot-Bouchard)

small (0.3-0.9 mm) diameter aneurysms that occur on small (0.1-0.3 mm) diameter arteries a distribution that matches incidence of hypertensive haemorrhages

80% lenticulostriate

10% pons

10% cerebellum

found in hypertensive patients may thrombose, leak (see cerebral microhaemorrhages) or rupture

accelerated atherosclerosis: affects larger vessels

hyaline arteriosclerosis

hyperplastic arteriosclerosis: seen in very elevated and protracted cases

Scales

ICH score

Clinical features

Weakness may be the initial symptom with a basal ganglia hemorrhage

Diagnosis

CT

Typically a region of hyperdensity is demonstrated centred on the basal ganglia or thalamus. Not infrequently there may be an extension into the ventricles, with occasionally the parenchymal component being very small or inapparent.

MRI

The appearance of haemorrhage on MRI varies with time and to some degree the size of the haematoma (see ageing blood on MRI).

Treatment

see Basal ganglia hemorrhage treatment.

Case series

see Basal ganglia hemorrhage case series.

1)
Lang EW, Ren Ya Z, et al. Stroke pattern interpretation: the variability of hypertensive versus amyloid angiopathy hemorrhage. Cerbrovasc Dis. 2001;12:121–30.
basal_ganglia_hemorrhage.txt · Last modified: 2020/02/25 16:49 by administrador