September 7, 2009
44-year-old man with sudden loss of consciousness and severe arterial hypertension.
Bilateral Symmetric Caudate Head Hemorrhage
- Cerebral hemorrhage limited to the head of the caudate nucleus is very rare (0.1-7%). Bilateral simultaneously caudate hemorrhages are extremely rare.
- Caudate hemorrhages occur mostly in the elderly, often those with long-standing arterial hypertension that causes lesions in the lenticulo-striate arteries.
- Severe stenosis/occlusion of a middle cerebral artery with a fragile anastomotic vessels or angiopathies in younger individuals (moyamoya-like disease) are less frequent but should be considered and excluded by angiography. Differential diagnosis: hypertension, lightning strike, amyloid, methanol, diabetic ketoacidosis, venous thrombosis and fungus (mucor, aspergillus).
