1. A 9-year old girl with multi-compartmental intracranial hemorrhage
Teaching NeuroImages
Neurology
Resident and Fellow Section
© 2016 American Academy of Neurology

2. Vignette
A previously healthy 9-year old girl presented with sudden onset headache followed by confusion. In the ED, she was hypertensive, bradycardic, and no longer responsive to any stimuli.
An emergent head CT scan demonstrated a left frontal intraparenchymal hematoma with intraventricular and subarachnoid extension as well as subfalcine herniation (figure).
Siegler, et al.
© 2016 American Academy of Neurology

3. Imaging
A) Axial CT of the head at presentation. Deep, intraparenchymal hemorrhage (arrow) with subarachnoid extension (arrowhead).
B) Coronal CTA of the head demonstrating intraparenchymal hemorrhage (asterisk), intraventricular extension (arrow), and middle cerebral artery aneurysm (arrowhead).
C) Digital subtraction angiography after decompressive hemicraniectomy (arrowheads indicate staples), confirming 7mm aneurysm (arrow).
Siegler, et al.
© 2016 American Academy of Neurology

4. Teaching NeuroImages: Multi-compartmental Intracranial Hemorrhage in a Pediatric Patient
Digital subtraction angiography confirmed a 7mm left middle cerebral artery aneurysm.
Intracranial hemorrhage that traverses multiple compartments has a short differential and should include:
Trauma
Vascular abnormalities (middle cerebral artery aneurysm, arteriovenous malformation, dural arteriovenous fistulas, and reversible cerebral vasoconstriction)
Cocaine abuse.
REFERENCES
1. van Gijn J and Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain. 2001;124:
2. Dainer HM and Smirniotopoulos JG. Neuroimaging of hemorrhage and vascular malformations. Semin Neurol. 2008;28:
Siegler, et al.
© 2016 American Academy of Neurology