BRAIN - Cerebral and pontine haemorrhage

Brain, cut to show, on the reverse side, a massive left-sided cerebral haemorrhage destroying the outer part of the caudate nucleus on the left, and extending into the ventricular system; the left side of the brain is swollen. On the front of the specimen, a massive pontine haemorrhage can be seen. The part of the basilar artery present shows no atheroma, but atheromatous plaques are visible in the middle cerebral arteries.
Approximately one week before his death, he experienced sudden severe headache and lost consciousness. He was known to be hypertensive. A lumbar puncture showed blood in the cerebrospinal fluid and clinically he showed a right hemiparesis with aphasia; his blood pressure was recorded as 180/100. Investigation showed that he had an intracerebral clot, lateral to the perforating vessels in the left hemisphere. It was thought that he might be managed conservatively until about fourteen days after the bleed, when removal of the clot would be easier; shortly after this decision had been made he lost consciousness and his left pupil became larger than the right; the left cerebral haemorrhage was explored and much of the clot removed, but his condition continued to deteriorate and he died some 18 hours later from the massive pontine haemorrhage apparent in the specimen.