Thalamic haemorrhage

Case contributed by Dr Mark Rodrigues

Presentation

Undergoing rehabilitation post hip fracture. Developed sudden onset dysphasia and right sided weakness. Reduced GCS. Past history of alcohol excess.

Patient Data

Age: 75 years
Gender: Male
CT

Large deep left sided acute intracerebral haematoma, with its epicentre in the thalamus. The haemorrhage extends into the intraventricular system.  There is no subarachnoid haemorrhage.

The haemorrhage displaces and compresses the third ventricle, resulting in obstructive hydrocephalus of the lateral ventricles.

Mild generalised cerebral volume loss. Moderate periventricular low attenuation in keeping with small vessel change.

Case Discussion

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

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PATHOLOGY

The patient died 7 days after the ICH and underwent a post mortem.  This showed an extensive left sided haemorrhage which is centred in the posterior basal ganglia and thalamus.  The haemorrhage extends caudally into the left cerebral peduncle and medially into the lateral ventricle.

There is prominent small vessel disease throughout the white matter plus enlarged perivascular space but no lacunar infarcts. Immunohistochemistry shows no significant amyloid angiopathy.

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Case information

rID: 58787
Published: 9th Mar 2018
Last edited: 9th Mar 2018
Inclusion in quiz mode: Included
Institution: University of Edinburgh

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