Intracranial Hemorrhage

Intracerebral Hemorrhage

Fig.11.5a This precontrast head CT shows parenchymal hemorrhage in the frontal lobe caused by a ruptured medial cerebral artery aneurysm. The hemorrhage has broken into the ventricle. b In another patient, massive hemorrhage has occurred in the right hemisphere. There is a slight associated SAH on the right. The mass effect is considerable: midline shift to the left of more than 2 cm has occurred. CSF flow is already impaired, as you can see by the dilatation of the anterior horn of the left lateral ventricle. Periventricular hypodensity as seen here is thought to be associated with high ventricular pressure. This patient, unfortunately, is beyond any promising therapeutic options.

for the cerebral angiography that is about to follow. There is indeed a severe SAH, the cause of which must be found and treated as soon as possible. Giufeng briefs Mr. Kling-ton's escorts about the findings and about what has to be done. The two ladies have known each other for a few hours only. One of them is Mr. Klington's girlfriend, the other is his wife. The girlfriend was absolutely helpless and desperate after the patient had collapsed in bed. She had telephoned Mrs. Klington for help, who was smart enough to alert and bring along the ambulance at the same time. Will Klington is lucky. The neurointerventional team finds the source of the bleed and during an intricate procedure obliterates the aneurysm with a few platinum coils. The patient leaves the hospital four weeks later without any lasting neurological deficits and with full restitution of his relevant physical abilities.

Only noncontrast cranial CT shows small hemorrhages with sufficient certainty. For that reason, emergency CT of the head needs to be done before any other CT examinations are performed and this first run must always be done without intravenous contrast.

I The Case of Anastasia Peabody-Smith

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