Intracerebral Haemorrhage - Erler Zimmer

Intracerebral Haemorrhage - Erler Zimmer

Clinical History

An 80-year-old man experienced a sudden loss of consciousness, accompanied by a right gaze palsy, left hemiplegia, and right hemiparesis upon examination.

Pathology

The specimens consist of coronal sections of the brain at the level of the mammillary bodies, revealing the cerebral peduncles and substantia nigra. More anterior sections include part of both temporal lobes. A massive blood clot has replaced cerebral tissue in the left basal ganglia and internal capsule. The hemorrhage originated in this area, rupturing into the left lateral ventricle and its temporal horn, destroying the left lateral ventricle walls and extending into adjacent brain tissue. The right lateral ventricle is also filled with blood, but its walls remain intact. The blood clot forms a space-occupying lesion, expanding the left cerebral hemisphere and causing mid-line structure displacement to the right. Subfalcine herniation of the left cingulate gyrus under the falx cerebri is observed (the latter has been removed).

Further Information

Intracerebral hemorrhages of this nature are typically complications of systemic hypertension. The hemorrhage results from the rupture of a microaneurysm in a branch of the striate arteries, which arise from the middle cerebral artery and supply the basal ganglia.