J Cerebrovasc Endovasc Neurosurg.  2016 Jun;18(2):106-109. 10.7461/jcen.2016.18.2.106.

Delayed Consecutive Contralateral Thalamic Hemorrhage after Spontaneous Thalamic Hemorrhage

• Han JH
• Jeon JP
• Choi HJ
• Yang JS
• Kang SH
• Cho YJ

• KMID: 2354884
• DOI: http://doi.org/10.7461/jcen.2016.18.2.106

Abstract

Simultaneous or subsequent bilateral thalamic hemorrhagic events have ranged from 12 to 19 in prior reports, with a time lag between bilateral thalamic hemorrhage of up to two days. Herein, we report the first case of delayed (17 days) consecutive contralateral thalamic hemorrhage after spontaneous first thalamic hemorrhage. A 65-year-old female initially presented with a drowsy mentality with a left-side motor weakness (grade II/III). Brain computed tomography (CT) demonstrated right side thalamic and intraventricular hemorrhage. She regained alertness with mild residual motor weakness (grade III/IV) under medical management. Seventeen days later, a sudden and generalized tonic-clonic seizure developed. Brain CT scans revealed a new contralateral thalamic hemorrhage coincident with microbleeds. Neurologic status remained unchanged, consisting of a stuporous mentality with quadriparesis of grade II/II. We report the first case of delayed consecutive contralateral thalamic hemorrhage up to 17 days after first thalamic hemorrhage. The case highlights the need for close monitoring of patients with thalamic hemorrhage who experience microbleeds on the contralateral side, due to the possibility of delayed hemorrhage.

Keyword

Intracranial hemorrhages; Hypertension; Thalamus

MeSH Terms

Aged
Brain
Female
Hemorrhage*
Humans
Hypertension
Intracranial Hemorrhages
Quadriplegia
Seizures
Stupor
Thalamus
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 (A) Brain computed tomography (CT) scans shows right-side thalamic hemorrhage with intraventricular hemorrhage. (B, C) Magnetic resonance imaging 15 days after initial thalamic hemorrhage shows subacute stage hematoma with microbleeds (arrows) on the contralateral thalalmus. (D) Emergent CT 17 days after first thalamic hemorrhage reveals a new contralateral thalamic hemorrhage coincident with microbleeds.

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