1. Diagnostic Challenge Pathology for Neurosurgery & Neurology Residents Department of Pathology University of Oklahoma Health Sciences Center, Oklahoma City, OK, U.S.A. Online Slide Case 3 History: The patient was a 55 year-old woman who developed left facial drop, left hand and arm numbness and worsening headache. She was admitted to the emergency room. At the time of admission, her blood pressure was 183/86 mm Hg. Her blood pressure in the next morning was 209/106 mmHg. She has a remote history of carcinoma of the uterine cervix. As per the patient, her headache was over two month long and was severe. Contributor: Kar-Ming Fung, M.D., Ph.D., karming-fung@ouhsc.edu Last updataded: 4/20/2009karming-fung@ouhsc.edu

2. MRI T1-Contrast Multiple lesions are present in the brain. Biopsy was performed on the left and right frontal lesion.

3. There are spongiotic changes and vascular proliferation (arrow). Permanent Section

4. Many histiocytes are present (arrow). Permanent Section

5. Numerous stellate shaped reactive astrocytes are present (arrow). Glial fibrillary acidic protein (GFAP)

6. The macrophages are highlighted by CD163. CD163

7. What is your diagnosis?

8. Diagnosis: Intracerebral hemorrhage associated with hypertension. Discussion: At the time when this patient is operated, the hemoarrhage must have happened a few days or perhaps a week ago. This is indicated by the vascular proliferation and intense histiocytic infiltration.