A CT scan of the head showed an acute
intraparenchymal hemorrhage (platelet count range 37,000/[micro]L-57,000/ [micro]L) in the left basal ganglia with intraventricular extension into the left lateral and third ventricles and hydrocephalus that required placement of an emergent external ventricular drain.
Studies have reported a 45-80% prevalence of cerebral palsy (CP) in survivors of
intraparenchymal hemorrhage (IPH).[2],[3],[4],[5],[6] The extent of hemorrhage (defined as the number of lobes involved on the worst-affected side) and ventriculomegaly (VM) is significantly associated with the development of CP; however, the laterality (unilateral vs.
Fortunately, despite the occurrence of
intraparenchymal hemorrhage, our patient did not develop any motor or sensory deficits and long-term vision loss.
A head CT demonstrated left frontal
intraparenchymal hemorrhage (IPH) measuring 1.2 x 2.6 cm with bilateral frontal and Sylvian fissure subarachnoid hemorrhage (Figure 1(a)) with hemorrhagic extension into the fourth ventricle; Fisher grade: IV.
Computed tomography (CT) disclosed
intraparenchymal hemorrhage with 2 cm diameter in the right frontal lobe (Figure 3(a)) and a fluid-attenuated inversion recovery (FLARE) image obtained by magnetic resonance imaging (MRI) disclosed subarachnoid hemorrhage at the right Sylvian fissure (Figure 3(b)).
Noncontrast CT head and the T2 [*] weighted MRI sequence are used to identify
intraparenchymal hemorrhage with the greatest sensitivity.
fracture extradural subdural and
intraparenchymal hemorrhage were noted.
Clinical evaluation and computed tomography of his head and face revealed a small
intraparenchymal hemorrhage of the right posterior temporal lobe, as well as a comminuted left parasymphyseal fracture and a displaced left mandibular angle fracture extending up thru the coronoid process (Figure 1).
CT without contrast was performed upon admission that revealed moderate intraventricular hemorrhage, small
intraparenchymal hemorrhage, and mild subarachnoid hemorrhage.
Each case covers basic principles of neuroanesthesia and neurocritical care, neuroimaging, and complications, and they relate to craniotomy, vascular procedures, spine and neuroendocrine surgery, functional neurosurgery, pediatric neuroanesthesia, neurologic sequelae in other patients, subarachnoid and
intraparenchymal hemorrhage, stroke, traumatic brain injury, seizures, neuromuscular disease, and end-of-life issues.
Other, less common types of intracranial hemorrhage, such as subarachnoid, intraventricular, and
intraparenchymal hemorrhage, have a more complex etiology, which includes birth asphyxia, hemorrhagic diathesis, infection, and vascular abnormalities.
Five microscopic features are seen: (a) compressed remnants of lymphoid tissue at the periphery; (b) spindle cells with nuclear palisading; (c)
intraparenchymal hemorrhage and erythrocyte extravasation; (d) so-called amianthoid fibers; and (e) intracellular and extracellular fuchsinophilic bodies that stain positive for smooth muscle actin.