Thalamic hemorrhage

Case contributed by Dr Mark Rodrigues

Presentation

Found with left facial droop, left hemiparesis. GCS initially 15 but subsequently decreased. Past history of alcohol abuse.

Patient Data

Age: 60 years
Gender: Male
CT

Deep right 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 the third ventricle slightly, and there is hydrocephalus of the lateral and third ventricles.

Severe generalized cerebral volume loss. Moderate periventricular low attenuation in keeping with small vessel change. Central gliosis within the pons may represent previous central pontine myelinosis or a chronic ischemic infarct.

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 10 days after the ICH and underwent a post mortem.  This showed a large hematoma centered in the right thalamus, which extends into the ventricular system.

There is significant small and large vessel cerebrovascular disease, with lipohyalinosis and arteriolosclerosis in the white matter, plus enlarged perivascular spaces. Central cystic area of degeneration in the pons consistent with previous central pontine myelinosis. Immunohistochemistry shows no significant amyloid angiopathy.

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Case information

rID: 58788
Published: 9th Mar 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: University of Edinburgh

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