Basal ganglia hemorrhage

Case contribution: Dr. Radhiana Hassan


  • An 87 years old lady
  • Underlying DM and HPT.
  • Presented with left sided body weakness.
  • Associated with slurred speech.
  • On examination E3V2M6. Power left upper and lower limb 0/5.
  • BP 239/112 mmHg.
CT scan brain in axial plane non-contrast

CT scan findings:

  • There is a large hyperdensity in the right basal ganglia (red arrows) measuring about 4.3x 4.4×4.3 cm (AP x W x CC) in keeping with acute hemorrhage.
  • There is extension of hemorrhage into the lateral, third and fourth ventricles (yellow arrows).
  • Midline shift to the left measuring about 10 mm.
  • Effacement of the adjacent cerebral sulci.
  • Underlying cerebral atrophy.

Diagnosis: Acute right basal ganglia hemorrhage with intraventricular extension.


  • Basal ganglia hemorrhage is a common form of intracerebral hemorrhage
  • It is a neurologic emergency that requires immediate imaging and neurosurgical referral
  • The most common cause is poorly controlled long-standing hypertension
  • Typically seen on CT scan as a region of hyperdensity centered on the basal ganglia or thalamus. Not infrequently there may be an extension into the ventricles.
  • Volume of the hemorrhage may be estimated by APxWxCC/2 formula, which may have neurosurgical and prognostic implications (only parenchymal hemorrhage not intraventricular extension).
  • The mainstay of treatment is medical, with control of hypertension and attempts to prevent secondary cerebral injury.
  • If an intraventricular hemorrhage is present then hydrocephalus is a common sequelae and CSF drainage with an extra-ventricular drain is often needed.
  • Evacuation of the clot is controversial and only potentially useful in large (>60 mL) hemorrhage.
Author: radhianahassan