Thalamic hemorrhage with intraventricular extension and obstructive hydrocephalus

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Pre alert for query stroke. New incontinence, headache and dysphasia. CT urgent for stroke?

Patient Data

Age: 75 years
Gender: Female

2.5 cm left thalamic hemorrhage with intraventricular extension and mild dilatation of the temporal horns.

No midline shift.

Four days later. GCS 6 e-1 m-4 v-1. Dense right-sided weakness, not responding to commands, known left thalamic bleed with intraventricular extension. Extension of bleed? Worsening hydrocephalus?

Unchanged thalamic and intraventricular hemorrhage.

The temporal horns are more dilated.

Increased periventricular low attenuation indicating worsening transependymal edema.

Case Discussion

A hypertensive thalamic hemorrhage leading to acute obstructive hydrocephalus due to intraventricular extension of the bleed.

Hypertension ('the silent killer') can result in significant and even fatal neurological outcomes.

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