Putaminal hemorrhage: Clinical-computed tomographic correlations

Abstract

Ninety-two percent of 100 patients with putaminal hemorrhage were hypertensive. Of the eight normotensive patients, seven were substance abusers or had bilateral putaminal hemorrhages. The one other normotensive patient was less than 40 years old. The 100 hemorrhages had the following locations: 1. medial putaminal (17 cases; six were normotensive and less than 40 years old and five were substance abusers); 2. lateral putaminal extending through the external capsule (eleven cases); 3. putaminal-capsular and subcortical white matter (32 cases); 4. putaminal cerebral hemispheric (19 cases); 5. putaminal-thalamic (19 cases); 6. bilateral (two cases). A disproportionate number of black patients suffered hematoma extension to the cerebral hemispheres or thalamus (46%) compared to Caucasians (23%). Overall mortality was 20% (17 blacks and three Caucasians) and occurred in patients with hematoma extension to the thalamus or cerebral hemispheres. Contrast-enhanced CT was performed in all 100 patients and provided no additional diagnostic yield. This indicates limited use for enhanced CT in hypertensive patients with putaminal hemorrhage who have a characteristic appearance of the acute hemorrhage on the nonenhanced CT.

Early prediction of aphasia outcome in left basal ganglia hemorrhage

“…The destruction of white matter structures surrounding the basal ganglia might be very important in causing aphasia (18, 19). Weisberg et al (20) observed 6 patients suffering from language dysfunction with putaminal hemorrhage extending into the temporal region. Since arcuate fasciculus fibers and insula may be injured by hematoma, conduction aphasia or incompetence of speech output is predicted (18, 21).…”

The Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS): Development and assessment of reliability

“…All raters had received training sessions from a senior neuroradiologist (H.R.J.) on anatomical regions, typical patterns of spread for lobar and deep ICH, [15][16][17] and characteristic examples ( Figure 2). Ratings were performed on IMPAX workstations.…”

“…Following the principles of ICH classification recommended in the STRIVE position paper, [7] in CHARTS the presumed ICH epicentre is classified (based on the definitions in Figure 2). [15][16][17] We included the 'uncertain' category to include challenging cases, for example when an ICH is very large and extends into both lobar and non-lobar areas. The rater should still categorise the origin of such an ICH as: "uncertain -probable lobar"; "uncertainprobable non-lobar"; or -for hematomas involving the majority of a hemisphereas "uncertain -holohemispheric".…”

Isolated basal ganglia hemorrhage due to blast injury

“…[1] There are some reports about bilateral basal ganglia hemorrhage etiologies like lightening, [2] diabetic ketoacidosis, [3] and alcohol and cocaine intoxication, [4] but only a few articles about trauma. [5,6] We report herein a case of bilateral basal ganglia hemorrhage due to blast injury.…”