420.Hypertensive Basal Ganglia Haemorrhage（II）

DIFFERENTIAL DIAGNOSIS

A haemorrhagic lesion centered in the basal ganglia may be seen in numerous conditions. The most common cause of spontaneous haemorrhage arising in the basal ganglia or thalami is hypertensive haemorrhage.

Additional imaging features suggestive of the diagnosis include evidence of prior haemorrhages in characteristic locations such as the deep gray matter nuclei (as is seen in this case), dentate nuclei, and brainstem, as well as leukoaraiosis commonly seen in patients with long-standing hypertension.

Amyloid angiopathy characteristically presents with lobar haemorrhage, and SWI may demonstrate evidence of remote, peripherally distributed haemorrhages elsewhere. Furthermore, haemorrhages due to amyloid angiopathy usually occur in patients over the age of 60.

Deep venous infarct in the internal cerebral veins can present with hypodensities in the thalami, which may simulate a resolving hypertensive haemorrhage.

Patients who are coagulopathic may also present with haemorrhage in the deep gray structures.

Haemorrhagic neoplasms can present in the basal ganglia. A contrast-enhanced MRI study is indicated to look for the presence of tumoral enhancement. Given the high prevalence of metastatic tumors to the brain compared to primary brain neoplasm, most haemorrhagic tumors are extracranial in origin.

Underlying vascular malformations, including arteriovenous malformations (AVMs) and cavernous malformations, can also present with haemorrhage. AVMs demonstrate a tangled collection of vessels in or adjacent to the ha Thursday haemorrhage on CTA or MRA, while cavernous malformations can demonstrate “popcorn like” calcifications on CT and a hemosiderin ring on MRI from recurrent haemorrhage.

Notes：

1. haemorrhagic  adj. 出血的

2. leukoaraiosis 脑白质疏松

3. amyloid angiopathy 血管淀粉样变，淀粉样血管病

4. coagulopathic 凝血障碍

5. extracranial /ˌekstrə'kreɪnɪəl/ /ˌɛkstrə'kreniəl/ 颅内脑外的

来源：每天朗读一段医学影像学英语文章

圈主

深圳市人民医院放射科副主任医师杨敏洁

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