Thalamic haemorrhage

Case contributed by Dr Mark Rodrigues

Presentation

Found in bed with dense left sided weakness

Patient Data

Age: 80 years
Gender: Female
CT

High attenuation centred on the right thalamus consistent with an acute haemorrhage. There is haemorrhage extension into the ventricular system.  No subarachnoid or subdural haemorrhage.

The haematoma and perilesional oedema result in compression and midline shift of the 3rd ventricle. The temporal horns of the lateral ventricles appear dilated in keeping with early hydrocephalus.

Marked periventicular and deep white matter low attenuation in keeping with severe small vessel disease. Mild generalised cerebral volume loss.

MRI

Rounded region of signal drop out on GRE. The mass effect demonstrated on the diagnostic CT has reduced, consisting with resolving right thalamic haematoma.

Several mixed lobar and deep microbleeds are present. Some prominent vessels in the basal ganlgia also result in focal areas of signal drop out. There may be an old haemorrhage at this site (left thalamus).

Severe periventricular and deep white matter hyperintensities, in keeping with small vessel disease. Small chronic cortical infarct in the right frontal lobe (MCA territory). Enlarged basal ganglia and centrum semiovale enlarged perivascular spaces. Mild to moderate generalised cerebral volume loss.

Case Discussion

Deep right intracerebral haemorrhage centred on the right thalamus. Its location and background brain features (white matter hyperintensities, enlarged deep perivascular spaces and mixed lobar and deep microbleeds) are in keeping with a "hypertensive" (arteriolosclerosis) haemorrhage.

There is extension into the ventricular system and evidence of early hydrocephalus on the diagnostic CT.

The patient underwent a post-mortem which showed an old right-sided thalamic haematoma, with severe small vessel disease. Immunohistochemistry showed very limited cerebral amyloid angiopathy in the parietal cortex only.

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Case information

rID: 58347
Published: 13th Feb 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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