Expansion of Thalamic Hemorrhage After Initial Presentation

Right thalamic hematoma at admission
Close up view of right thalamic hematoma at admission
CT done 48 hours later shows hematoma expansion and increase in mass effect
Close up view of expanded right thalamic hematoma 48 hours after admission

Intracerebral hemorrhage (ICH) accounts for 20-35% of all strokes. Hypertension is the commonest underlying cause of ICH. The common sites for hypertensive ICH are putamen, thalamus, pons, cerebellum, subcortical and lobar hematomas. Basal ganglia (putamen) is the most common site for ICH accounting for about 50% of all cases. Thalamus holds the second position and is the site of ICH in about 25% of cases.

Hematoma expansion occurs in about one third of all cases. Factors predicting hematoma expansion are: 1. Severe hypertension, 2. Larger hematoma size at admission, 3. Use of anticoagulants, 4. Early presentation after symptom onset.

Outcome after thalamic bleed: After 3 months follow up, 50% have a favourable outcome (mRS<4). About 28% die by 3 months.

Predictors of poor outcome after thalamic bleeds: 1. Male sex, 2. Larger hematoma volume (>20 ml), 3. Dominant side bleed, 4. Preoperative low GCS (<8), 5. Need for EVD, 6. Older age

In the CT scans above, you can see right sided thalamic bleed. The top two scans show the bleed at admission. The bottom two CT scans taken 48 hours after initial admission show expansion of hematoma and increase in mass effect (third and right lateral ventricles are compressed).

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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