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Related Subjects: |Subarachnoid Haemorrhage |Perimesencephalic Subarachnoid haemorrhage |Haemorrhagic stroke |Cerebellar Haemorrhage |Putaminal Haemorrhage |Thalamic Haemorrhage |ICH Classification and Severity Scores

Patients with a thalamic stroke can behave as if they are sleeping rather than comatose

About

• Common form of deep primary intracerebral haemorrhage

Causes

• Hypertensive rupture of small penetrating vessels by far the commonest cause
• Localised AV malformation of cavernoma
• Cerebral Amyloid angiopathy
• Tumour or localised abscess
• Anticoagulants
• Cerebral Venous thrombosis of deep veins in procoagulant patient
• Cocaine and other drugs
• Sickle cell disease

Clinical correlation with location

• Somnolence is seen in most especially if bilateral disease
• Inferior-Lateral : weakness and clumsiness, as well as tremor and choreathetoid type movements as fibres to cerebellum and dentate nucleus, affected
• Lateral thalamic bleed: mainly sensory symptoms but motor symptoms too if the posterior limb of the internal capsule is squeezed. Eye movement and pupil abnormalities seen.
• Dorsal medial lesions give sometimes profound memory loss and some behavioural changes.
• Left sided lesions may cause a thalamic aphasia
• Right sided lesions associated with some neglect

Complications

• Further bleeding leading to pressure on brainstem causing coma and death
• Obstructing CSF flow leading to hydrocephalus

Investigations

• CT head is usually diagnostic
• MRI may be performed

Management

• Correct any coagulopathy e.g. Octaplex or Beriplex or similar for Warfarin
• Admit stroke Unit and manage as any haemorrhagic stroke
• Ventriculostomy is indicated in patients with haemorrhage and hydrocephalus.
• Little evidence of neurosurgical benefit from clot evacuation