case_images: PMC9282792_01
case_images: Brain CT of the patient. Noncontrast CT scan (a: axial and b: coronal views) showing hematoma adjacent to the right trigone, intraventricular hemorrhage, diffuse subarachnoid hemorrhage, edematous brain, and hydrocephalus. Contrast-enhanced CT scan in the axial view (c) showing abnormal vasculature with an artery originating from the right posterior cerebral artery (white arrow), vein draining into the right transverse sinus (black arrow), and hematoma (dotted arrow).
case_images: SNI-13-284-g001.jpg
case_images: PMC9282792_01_SNI-13-284-g001.jpg
case_images: F1
case_images: After achieving hemodynamic stability by administering catecholamine, a brain CT scan was performed, which showed an intracerebral hemorrhage (ICH) adjacent to the right trigone with massive intraventricular hemorrhage (IVH) and subarachnoid hemorrhage (SAH) [Figures 1a and b]. A contrast-enhanced CT scan was performed to investigate the cause of ICH, which showed abnormal vessels adjacent to the hematoma [Figure 1c].
case_images: Pathological findings of the patient. A coronal section of the fixed brain (a) showing subarachnoid hemorrhage at the brain surface and hematoma in the right parahippocampal area although close to the right trigonum (encircled in a), with blood extending into the lateral ventricles. A 20 x 10 x 10 mm mass of blood vessels (b). Staining with hematoxylin and eosin (c) and Elastica van Gieson (d) showing small blood vessels with variable size, shape, and wall thickness. Thin-walled vessels had the appearance similar to veins but contained elastic fibers, which confirmed that they were arteries (dotted arrow in d). Some vessels showed abnormal partially thickened walls with discontinuous elastic fibers (arrow in d).
case_images: SNI-13-284-g002.jpg
case_images: PMC9282792_01_SNI-13-284-g002.jpg
case_images: F2
case_images: Sections of the fixed brain showed a hematoma in the right parahippocampal area although close to the right trigonum [Figure 2a], with blood extending into the entire ventricular system. A mass of blood vessels (20 x 10 x 10 mm in size) was seen within the hematoma [Figure 2b]. On microscopy, small blood vessels in the vascular mass had variable size, shape, and wall thickness [Figure 2c]. Some vessels had abnormal, partially thickened walls with discontinuous elastic fibers [Figure 2d] and medial smooth muscle.