Hypertensive thalamic hemorrhage followed by subcapital femoral fracture
Presentation
The patient fell from his own height while was dressing. Right hip and wrist pain and disturbed level of consciousness.
Patient Data
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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