CT without contrast T2 axial FIR coronal

Diagnosis: Acute lobar hemorrhage most likely secondary to systemic hypertension.

Causes of intracerebral lobar hematoma include hypertension, amyloid angiopathy, underlying AVM or aneurysm, hemorrhagic neoplasm, cocaine abuse, coagulopathies, and hemorrhagic infarction. Most hypertensive hemorrhages occur in the basal ganglia; however, a significant minority may be lobar. Hemorrhage due to amyloid angiopathy is classically lobar and may be multiple. Patients are usually elderly, normotensive, and demented. Underlying hemorrhagic neoplasm is also a possibility in any intracranial hemorrhage. If this is suspected, follow-up imaging may show interval resolution of the hematoma and progression of the underlying neoplasm. AVM and aneurysm are also important considerations as etiologies for intracerebral hematoma. The lobar location of this hematoma suggests amyloid angiopathy; however, the history of hypertension and the lack of multiplicity is more consistent with a hypertensive etiology. Underlying neoplasm, AVM or aneurysm can not be ruled out by this single exam. Follow-up imaging or angiography may be performed to rule out these etiologies. Related Cases

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