Thalamic hemorrhage

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 hematoma, with its epicenter in the thalamus. The hemorrhage extends into the intraventricular system.  There is no subarachnoid hemorrhage.

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

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

Case Discussion

Deep left 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 7 days after the ICH and underwent a post mortem.  This showed an extensive left sided hemorrhage which is centered in the posterior basal ganglia and thalamus.  The hemorrhage 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: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: University of Edinburgh

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