Presentation
Altered mental status. Onset of right-sided weakness same day.
Patient Data
There is a large left intraparenchymal hemorrhage in the region of the basal ganglia which extends into the left lateral ventricle. There is adjacent mass effect with rightward midline shift and minimal subfalcine herniation.
Diffuse intraparenchymal hemorrhage in the region of the left basal ganglia with curvilinear hyperdensity compatible with extravasation of contrast medium.
Case Discussion
This is a case of the angiographic spot sign, which may indicate active hemorrhage.
The patient was admitted to the neurological intensive care unit where his course was complicated by worsening mental status, multiple failed videofluoroscopic swallowing studies, and MSSA pneumonia. After some time, the patient began to improve and was admitted to the stepdown unit and, eventually, to a rehabilitation facility.
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