Thalamic hemorrhage

Case contributed by Dr Mark Rodrigues

Presentation

Collapse with sudden onset right sided weakness and slurred speech

Patient Data

Age: 90 years
Gender: Female
CT

Small region of high attenuation centered in the left thalamus extending cranially into the corona radiata, in keeping with an acute hemorrhage.  No intraventricular, subdural or subarachnoid extension. Small volume of perihaematomal edema but no midline shift or hydrocephalus.

Moderate periventricular and deep white matter low attenuation in keeping with small vessel change. Moderate generalized cerebral volume loss.

MRI

Slit like region of signal drop out in the left thalamus at the site of previous hemorrhage.  No other sites of macro or microbleeds.  No superficial siderosis.

Moderate periventricular and deep white matter hyperintensities.  Multiple elarged perivascular spaces in the basal ganglia and centrum semiovale. Moderate generalized cerebral volume loss

 

Case Discussion

Deep left intracerebral hemorrhage centered on the left thalamus. Its location and background brain features are in keeping with a "hypertensive" (arteriolosclerosis) hemorrhage.

The patient underwent a post-mortem which showed an old left thalamic hematoma. There was extensive small vessel disease with enlarged perivascular spaces, white matter rarefaction, and small lacunar infartcs. There was no significant amyloid angiopathy.

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Case information

rID: 58342
Published: 13th Feb 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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