Computed Tomographic (CT) Findings in Cases of Putaminal Hemorrhages with Hemiplegia that Have Taken a Favorable Course

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Abstract
Computed tomography (CT) findings were analyzed in 17 cases of putaminal hemorrhage accompanied by hemiplegia which had subsided almost completely by conservative therapy within one month after the onset of the disease. The results obtained are as follows : 1) In cases of putaminal hemorrhage, it was difficult to determine from CT findings whether or not the hemorrhage had reached the posterior limb of the internal capsule, since the limb was usually shifted medially by the hematoma; 2) In such putaminal hemorrhage cases where high density area was not seen at the level showing bodies of the lateral ventricles on CT scan, disturbance of consciousness was slight and hemiplegia improved with conservative therapy; 3) In order to interpret the reason for this, a triangle on the coronary section passing through the posterior part of the posterior limb of the internal capsule was supposed.That is, the triangle is formed by three margins;the base of the triangle marked by a line from the stria terminalis(A-point) to the insula of the same level (B-point), the lateral margin by a line running down from B-point to the upper end of the putamen (C-point) and the medial margin by a line from A-point to C-point. Thus, the relationship between the triangle and the extent of hematoma was investigated; 4) In putaminal hemorrhage, destruction of the pyramidal tract due to hematoma starts from this triangle because the triangle corresponds to the foot of the corona radiata and is most vulnerable to hematoma. Therefore, we call it the “vulnerable triangle.” This triangle is destroyed first and when the hematoma advances further, the posterior limb of the internal capsule is then destroyed; and 5) In cases showing findings of high density area on the CT scan at the level of bodies of the lateral ventricles, the vulnerable triangle may have been damaged and this is an ominous sign for prognosis.

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