An expanding intracerebral haematoma

Abstract

A 44 year old man presented to the emergency department with a sudden onset headache. He had no medical history of note and took no drugs. Urgent computed tomography of the head was performed (fig 1). A repeat scan (eight minutes later) was performed after administration of intravenous contrast (OptiRay) (fig 2). Upon return from the radiology department, he developed left sided hemiplegia. His blood pressure was 179/90 mm Hg. After another 46 minutes, computed tomography ( fig 3) with angiography (not shown) was performed; no abnormal vessels were seen. Blood tests did not show an underlying coagulopathy. He subsequently deteriorated to localising to pain and making incomprehensible sounds to pain without opening his eyes (Glasgow coma score 8). His pupils remained equal and reactive to light.