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.