Asymptomatic Intracerebral
Hematoma as an Incidental Finding
Richard A. Rudick, MD

Tntracerebral hemorrhage is being
diagnosed with increasing frequency in less severely ill "stroke"
patients.1-3 An unexpected basal gan-

glia hemorrhage was diagnosed by
computed tomographic (CT) scan in an
asymptomatic 59-year-old woman.

The scan was obtained as part of the
diagnostic evaluation of a seizure disorder of 18 years' duration. This further expands the clinical spectrum of
intracerebral hematoma.

Fig 2—Scan obtained seven days after
in Fig 1 shows hematoma partially
resolved, with surrounding edema.

scan

REPORT OF A CASE
A 59-year-old right-handed woman came
to the Strong Memorial Hospital Neurology Clinic, Rochester, NY, in January 1978
for evaluation of a seizure disorder. Her
seizures began at age 41 years and were of
the partial-complex type, with alteration of
consciousness and motor automatisms. Sei-

phenytoin sodium, phenobarbital, and primidone. Several
EEGs showed paroxysmal bitemporal slowing. She had a long history of treated
hypertension, chronic renal failure, adezures were controlled with

quately treated syphilis (with a negative
CSF VDRL), severe degenerative joint disease, and marked obesity.
In searching for a lesion that was
responsible for her seizure disorder, a CT
scan was done. On

Feb 1, 1978, a routine

outpatient CT scan of the head, without

contrast enhancement, showed a small left

basal ganglia hematoma, without signifi¬
cant mass effect or midiine shift (Fig 1).

Later that day the patient was unavailable
because she had gone shopping. On Feb 2
she declined to return because she was
feeling well. She denied headache, seizures,
or nausea.

On Feb 8 she came to the clinic on the

urging of her physician. Other than slight
lethargy, unilateral asterixis, and minimal¬
ly slowed movements of her right upper
extremity, she had no abnormal neurologic
signs. Her blood pressure was 200/120 mm
Hg. A second CT scan on Feb 8 showed the
hematoma to be slightly larger but of
decreased density, again without shift of
midiine structures (Fig 2). She was admit¬
ted for observation. Her blood level of
phénobarbital was 41 /ng/mL; with reduc-

Accepted for publication Sept 28, 1980.
From the Department of Neurology and Center for Brain Research, University of Rochester
School of Medicine and Dentistry, Rochester,
NY.

Reprint requests to Department of Neurology,
Strong Memorial Hospital, The University of
Rochester Medical Center, 601 Elmwood Ave,
Rochester, NY 14642 (Dr Rudick).

Fig 1.—Left basal ganglia hemorrhage.

Fig 3—Scan obtained 17 days after scan
in Fig 1 shows complete resolution of
blood density but some residual edema.

tion of dosage, her mental state quickly
returned to normal and her asterixis and
slowed right arm movement quickly
resolved.
On Feb 17 a third CT scan showed reso¬
lution of the intracerebral hematoma, with
some residual decreased density thought to
represent edema (Fig 3). She has since had
only occasional partial-complex seizures
and intermittent symptoms of uremia.
COMMENT

In this patient, a CT scan was done
as part of an évaluation of a seizure
disorder; the finding of a fresh, small
basal ganglia hemorrhage was unex¬
pected. In fact, the patient came to
the hospital alone by bus, and follow¬
ing her CT scan went shopping. She
felt well during the entire time sur¬
rounding the hemorrhage.
Computed tomographic scanning is
highly sensitive in detection of small

hemorrhages. Computed tomographic
findings of intracerebral hemorrhage"
'

and patterns associated with hemor¬
rhages in various locations have been
described.7 However, the occurrence
of a clinically unnoticed intracerebral
hemorrhage diagnosed by CT scan
done for other reasons has not been
previously recorded.
This case demonstrates that clini¬
cally unnoticed intracerebral hemor¬
rhage can occur, and may be more
frequent than is appreciated.

References
1. Pineda A: Computed tomography in intracerebral hemorrhage. Surg Neurol 1977;8:55-58.
2. Caplan R, Mohr JP: Intracerebral hemorrhage: An update. Geriatrics 1978;33:42-45, 48\x=req-\
52.
3. Herman T, Satya-Murti S: Benign cerebellar
hemorrhages. Ann Neurol 1978;3:366-368.
4. Scott WR, New PFJ, Davis KR, et al: Computerized axial tomography of intracerebral
and intraventricular hemorrhage. Radiology

1974;112:73-80.

5. Hayward RD, O'Reilly GVA: Intracerebral
hemorrhage. Lancet 1976;1:1-4.
6. Weisberg LA: Computerized tomography
in Intracranial hemorrhage. Arch Neurol

1979;36:422-426.
7. Ojemann RG, Mohr JP: Hypertensive brain
hemorrhage. Clin Neurosurg 1975;23:220-244.

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