Thalamic haemorrhage

Case contributed by Dr Mark Rodrigues

Presentation

Collapse with sudden onset right sided weakness and slurred speech

Patient Data

Age: 90 years
Gender: Female
CT

Small region of high attenuation centred in the left thalamus extending cranially into the corona radiata, in keeping with an acute haemorrhage.  No intraventricular, subdural or subarachnoid extension. Small volume of perihaematomal oedema but no midline shift or hydrocephalus.

Moderate periventricular and deep white matter low attenuation in keeping with small vessel change. Moderate generalised cerebral volume loss.

MRI

Slit like region of signal drop out in the left thalamus at the site of previous haemorrhage.  No other sites of macro or microbleeds.  No superficial siderosis.

Moderate periventricular and deep white matter hyperintensities.  Multiple elarged perivascular spaces in the basal ganglia and centrum semiovale. Moderate generalised cerebral volume loss

 

Case Discussion

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

The patient underwent a post-mortem which showed an old left thalamic haematoma. There was extensive small vessel disease with enlarged perivascular spaces, white matter rarefaction, and small lacunar infartcs. There was no significant amyloid angiopathy.

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Case information

rID: 58342
Published: 13th Feb 2018
Last edited: 7th Mar 2018
Inclusion in quiz mode: Included

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