Cerebral Parenchymal Haematoma

cerebral parenchymal haematoma

This 66 year-old female was admitted with myocardial infarction, left ventricular failure, atrial fibrillation, massive pulmonary embolus, shock, ischaemic liver and renal impairment. She was anticoagulated with heparin and warfarin. During admission she developed headache, confusion and reduced level of conciousness.

This axial image from non-contrast CT of the brain shows a large temporal haematoma with fluid-fluid level consistent with non-clotted blood. There was extension of the haemorrhage to the subarachnoid space. There is hydrocephalus, which may be secondary to obstruction of arachnoid villi by blood. There is right uncal herniation, with the temporal horn of the right lateral ventricle displaced medially.

The presence of a fluid-fluid level within a haematoma should alert one to the possibility of underlying coagulopathy. Fluid-fluid levels are present in up to 50% of patients when haemorrhage results from coagulopathy (this includes anticoagulation and thrombolysis).

Osborn A. Diagnostic Neuroradiology 1st edition. Mosby 1994.

Credit: Dr Laughlin Dawes