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Images in Neurology
March 2018

Atypical Cause of “Typical” Hypertensive Intracranial Bleeding

Author Affiliations
  • 1Department of Neurology, University of Texas Health Science Center at Houston
JAMA Neurol. 2018;75(3):373. doi:10.1001/jamaneurol.2017.4099

A man in his 50s with no known medical history presented with acute left hemiplegia. Noncontrast computed tomography of the head revealed right putamenal and intraventricular hemorrhage (Figure, A). Blood pressure at presentation was 211/100 mm Hg, without evidence of chronic hypertension on echocardiogram or electrocardiogram. Computed tomography angiography of the brain revealed occlusion of the right middle cerebral artery (MCA) with abnormal surrounding vasculature. Digital subtraction angiography demonstrated proximal MCA occlusion with dysplastic lenticulostriate branches serving as bypass to the distal-M1 MCA segment (Figure, B), suggesting that the cause of the hemorrhage was dysplastic vessel rupture. He was treated with blood pressure reduction medication, and an MCA bypass was planned to reduce flow in the dysplastic vessels.

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