Thalamic hemorrhage

Case contributed by Dr Mark Rodrigues

Presentation

Found unresponsive in bed. GCS 8. Past history of COPD and angina (on aspirin)

Patient Data

Age: 80 years
Gender: Male
CT

Large deep right sided acute intracerebral hematoma, with its epicenter in the thalamus. The hemorrhage extends into the intraventricular system.  There is no subarachnoid hemorrhage.

There is marked dilatation of the entire ventricular system consistent with hydrocephalus.  Mild midline shift to the left.

Mild generalized cerebral volume loss. Moderate periventricular low attenuation in keeping with small vessel change +/- transependymal CSF spread.

Case Discussion

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

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PATHOLOGY

The patient died the same day as the ICH and underwent post mortem.  This showed an extensive right sided cerebral hemorrhage centered in the thalamus and extending into the ventricular system, which is distended.

Throughout the cerebral and cerebellar white matter there is small vessel disease in the form of lipohyalinosis and arteriolosclerosis. Immunohistochemistry shows no significant vascular amyloid.

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Case information

rID: 58786
Published: 9th Mar 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: University of Edinburgh

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