Intracranial haemorrhage

Bottom 2 NCCT head  images are of a  patient on admission. Top 2 images are NCCT head few days of admission. Note that fresh right frontal haematoma has appeared and also right cerebellar haematoma has increased in size.

A 40 yrs old man who was heavy consumer of alcohol presented in emergency with acute onset severe headche and altered sensorium. The episode occured after consumption of alcohol in evening hours. What do you think is the possible diagnosis? He was appropriately investigated.

Patient was not on antiplatelet drugs, anticoagulants which could have caused bleeding. Had no history of liver or spleen disease. There was no history of high grade fever to suggest that he was suffering from Dengue. There was no history to suggest vasculitis. The intracranial bleeds do not suggest Moya Moya disease. The CT picture does not suggest  the bleed is in primary or metastatic brain tumour. Platlet count and INR were within normal limits.  Patient has right intracerebellar bleed and subrachnoid haemorrhage which has increased over a period of few days and also right frontal intracerebral bleed has developed. CT angio brain was done with venous phase. The picture given below shows complete thrombosis of right sigmoid sinus thrombosis.

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intracranial haemorrhage
written by sharmakchand, March 18, 2014
I have edited blog and added picture of CT angio in venous phase showing right sigmoid sinus thrombosis.
Comment about ICH
written by admin, March 19, 2014
We got the following comment via email. Please observe, this comment was sent before the blog entry was updated:

The most common causes of ICH were rupture of an arteriovenous malformation in 67 patients (33%), cavernous angioma in 32 (16%), and hypertension in 22 (11%). In 29 patients (15%) we could not demonstrate the cause of ICH, and in 12 patients (6%) the diagnostic workup was incomplete.

Cryptogenic ICH was considered in 15%. Other causes included cerebral venous thrombosis (5%) and sympathomimetic drug use (4%).

The most frequent risk factors were tobacco use (20%), hypocholesterolemia (35%), hypertension, (13%), and alcohol use (10%).
intracranial haemorrhage
written by sharmakchand, March 19, 2014
Thanks for your comments That venous sinus thrombosis is very common during summer months in India, when lot of fluid is lost, venous thrombosis in brain becomes a very common emergency. I will review venous infarct of brain later..

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