Hypertensive thalamic haemorrahge followed by subcapital femoral fracture

Case contributed by Dr Mohammad A. ElBeialy

Presentation

The patient fell from his own height while was dressing. Right hip and wrist pain and disturbed level of consciousness.

Patient Data

Age: 75 years
Gender: Male

A left thalamic acute hyperdense hematoma is seen about 4.2 x 3 x 3.7 cm in its maximal axial and cranio-caudal dimensions with its average density of 57 hounsfield unit (HU). Intraventricular extension of the hematoma is noted within the 3rd as well as the 4th ventricles and the atrium, trigone and occipital horn of the left lateral ventricle. Mild to moderate dilatation of the ventricular system as well as a periventricular hypodensity consistent with transependymal interstitial retrograde CSF permeation.

Bilateral rather symmetrical deep white matter patchy hypodensity consistent with periventricular arteriosclerotic leucoenecphalopathy and chronic small vessel disease.

Left anterior temporal extra-axial arachnoid cystic lesion is seen measuring about 4 X 2.5 X 3 cm in its axial and cranio-caudal dimensions respectively with mild mass effect on the left anterior temporal lobe. Small hypodense lesions are noted within the pons consistent with small vessel disease. Prominent extra-axial CSF spaces with no otherwise extra-axial hemorrhage.

Right femoral subcapital fracture with shortening of the right femoral neck as well as disturbed right Shenton’s line.

Case Discussion

Acute left thalamic hypertensive cerebral hemorrhage with intra-ventricular extension as well as mild to moderate hydrocephalus.  The patient fell down from his height and this was further complicated by right subcapital femoral fracture.  

 

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Case Information

rID: 46920
Case created: 23rd Jul 2016
Last edited: 25th Jul 2016
Inclusion in quiz mode: Included

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