Simultaneous hypertensive intracerebral haemorrhages: what are the odds?

Abstract

The simultaneous development of two (or more) spontaneous, hypertensive, non-traumatic intraparenchymal cerebral haemorrhages is rare and constitutes less than 5.6% of all hypertensive cerebral haemorrhages. In addition to having a high early mortality, these haemorrhages carry a considerable morbidity figure in patients who survive the event. We report a 68-year-old hypertensive and diabetic woman who presented with a sudden onset of headache, vomiting, and dense right-sided weakness. In less than an hour, she became obtunded. An urgent non-contrast CT brain scan revealed two left-sided supratentorial hemispheric haemorrhages; putamenal and thalamic.

Figure 1

Urgent non-contrast axial CT brain scan of the patient at the time of A&E admission. Note the presence of two left-sided hyperdense hemispheric lesions. These are putamenal (red arrow) and thalamic (yellow arrow) haemorrhages. The lack of surrounding (cytotoxic) oedema indicates a very early presentation. Both haematomas behaved as very rapidly growing space-occupying lesions, have compressed the ipsilateral ventricular system and have resulted in a midline shift of brain structures. The patient became obtunded in less an hour.

Figure 2

Non-contrast axial CT brain scan of the patient 58 days after the first event. Note the presence of two small oval-shaped hypodensities at the left putamen and thalamus. These represent the site of the previous corresponding haemorrhages. The patient has right-sided spastic hemiparesis and is dyphasic.