Lobar Haemorrhage Radiology Case

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Lobar haemorrhage 
Case contributed by Frank Gaillard
Diagnosis certain
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disclosures and
case data
Presentation
Sudden deterioration in conscious state.
Patient Data
Age: 60 years
CT
Axial Sagittal Coronal

non-contrast non-contrast non-contrast
CT without contrast demonstrates a very large

lobar haemorrhage occupying most of the
frontal lobe and extending into the ventricles.
It exerts marked positive mass e!ect.
On the left there is evidence of a previous

infarct.
Case Discussion
The patient went onto have the clot evacuated
and a small sample of tissue sent to histology.
Histology
Sections show abundant fresh blood

clot, containing layers of degenerating
neutrophils and fibrin alternating with red
cells. There is an accumulation of blood
beneath the leptomeninges, which contain
scattered vessels of varying calibre showing
mural thickening with some luminal
narrowing, and amorphous eosinophilic
material within the wall that is strongly
suggestive of amyloid. Congo red stains this
material, which shows apple-green
birefringence on polarisation.
A small fragment of oedematous cortex and

white matter is sampled. This shows a mild
astrocytosis. Only small capillary-sized vessels
are seen, however, these are normal in
appearance. There is no evidence of a vascular
malformation.
FINAL DIAGNOSIS: Intracerebral haematoma,

cortex over frontal cerebral haematoma and
leptomeningeal vessels showing amyloid
angiopathy.
Discussion
Lobar haemorrhages are typically seen in

elderly patients and in most cases attributable
to cerebral amyloid angiopathy. In young
patients, a lobar haemorrhage should be
viewed with suspicion and an underlying lesion
sought.
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Axial Sagittal Coronal

CT without contrast demonstrates a very large

On the left there is evidence of a previous

Sections show abundant fresh blood

A small fragment of oedematous cortex and

FINAL DIAGNOSIS: Intracerebral haematoma,

Lobar haemorrhages are typically seen in

+ 4 articles feature images from this case

+ 47 public playlists include this case

× Related Radiopaedia articles

Cerebral amyloid angiopathy

× Promoted articles (advertising)

CAR designs for solid tumors: overcoming

Biochemical and biophysical

Cellular and animal models to investigate

Cellular and animal models to investigate

Preface to the special issue of Phase

A basic phosphoproteomic-DIA workflow

ADVERTISEMENT: Supporters see fewer/no ads

How to use cases

You can use Radiopaedia cases in a variety

Add cases to playlists

Creating your own cases is easy.

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