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DOI: 10.1055/s-0037-1606208
Bilateral Traumatic Thalamic Hemorrhage: A Rare Clinical Presentation
Address for correspondence:
Publikationsverlauf
Received: 25. August 2016
Accepted: 15. Juni 2017
Publikationsdatum:
12. Oktober 2017 (online)
Abstract
Bilateral traumatic thalamic hemorrhage is a very rare occurrence, especially after head trauma, and is limited to case reports. The authors present a 27-year-old man, admitted for head trauma causing bilateral thalamic bleeding. Posttraumatic intracerebral bleeding is caused by focal or diffuse axonal injury. Bilateral traumatic thalamic hemorrhage is a rare clinical and radiologic presentation.
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Introduction
The thalamus is one of the areas site most affected by intra-cerebral hemorrhage.[1] [2] [3] Hypertension and diabetes mellitus, as well as antiaggregant and anticoagulant usage, are some of the risk factors for thalamic bleeding.[4] However, bilateral thalamic hematoma after trauma is extremely rare. The authors present a case of symmetrical and bilateral thalamic hemorrhage with a literature review.
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Case Report
A 27-year-old man was admitted to the hospital following a head trauma. Initial neurologic evaluation revealed a comatose patient with a score of Glasgow 3/15, bilateral mydriasis unresponsive, and absence of brainstem reflexes. His computed tomography (CT) of the brain ([Figs. 1], [2]) showed a bilateral thalamic hemorrhage, intraventricular hemorrhage, and cerebral edema without hydrocephalus. The patient died 48 hours after admission.
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Discussion
The prevalence of thalamic hemorrhage in different series of primary intracerebral hemorrhage vary widely from 6% in the series of Juvela[5] to 15.7% in the series of Tatu et al.[6] However, the general incidence of traumatic basal ganglia hemorrhage is reported between 2.4 and 3% of closed head injury.[7] The incidence is higher in postmortem studies (9.8%).[7]
Bilateral thalamic bleeding occurs mainly due to methanol intoxication, coagulopathies, vasculitis, and infection. Primary hypertensive thalamic hemorrhage is usually unilateral.[8]
Traumatic intracerebral hemorrhage occurs usually at the tip of frontal and temporal poles because of closeness to bony parts, but the thalamic seat is an uncommon clinical and radiologic presentation.[9]
The mechanism is unclear though it is proposed to arise from shear strain of the lenticulostriate or anterior choroidal vessels caused by acceleration/deceleration forces at the time of injury.[9] Both coup and counter coup injuries can cause this and this may cause bilateral lesions.[9]
Thalamic hemorrhage can occur by different clinical profiles (sensorimotor disturbances, speech disorders, lacunar syndrome). Diagnosis is easy to install on a CT of the brain, and in this case, we found a bilateral thalamic hematoma producing a mirror image.
Thalamic hemorrhage is a severe clinical condition. The initial level of consciousness was always found to be a predictor of mortality in the different series.[10]
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Conclusion
Thalamus may be the seat of posttraumatic bleeding with even a bilateral and symmetrical location.
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References
- 1 Kwak R, Kadoya S, Suzuki T. Factors affecting the prognosis in thalamic hemorrhage. Stroke 1983; 14 (04) 493-500
- 2 Weisberg LA. Thalamic hemorrhage: clinical-CT correlations. Neurology 1986; 36 (10) 1382-1386
- 3 Hankey GJ, Stewart-Wynne EG. Amnesia following thalamic hemorrhage. Another stroke syndrome. Stroke 1988; 19 (06) 776-778
- 4 Bülen þ, Omoúlu S, þahün Y, Zbakir þ. Thalamic hemorrhage (presentation and prognosis of hemorrhages). Turk J Med Sci 2001; 31: 421-423
- 5 Juvela S. Risk factors for impaired outcome after spontaneous intracerebral hemorrhage. Arch Neurol 1995; 52 (12) 1193-1200
- 6 Tatu L, Moulin T, El Mohamad R, Vuillier F, Rumbach L, Czorny A. Primary intracerebral hemorrhages in the Besançon stroke registry. Initial clinical and CT findings, early course and 30-day outcome in 350 patients. Eur Neurol 2000; 43 (04) 209-214
- 7 Bhargava P, Grewal SS, Gupta B, Jain V, Sobti H. Traumatic bilateral basal ganglia hematoma: a report of two cases. Asian J Neurosurg 2012; 7 (03) 147-150
- 8 Sarkar N, Roy BK, Das SK, Roy T, Dhibar T, Ghorai S. Bilateral intracerebral haemorrhages: an atypical presentation of Japanese encephalitis. Vol 53 JAPI; 2005
- 9 Calderon-Miranda WG, Alvis-Miranda HR, Alcala-Cerra G, M. Rubiano A, Moscote-Salazar LR. Bilateral traumatic basal ganglia hemorrhage associated with epidural hematoma: case report and literature review. Bull Emerg Trauma 2014; 2 (03) 130-132
- 10 Arboix A, Comes E, García-Eroles L. et al. Site of bleeding and early outcome in primary intracerebral hemorrhage. Acta Neurol Scand 2002; 105 (04) 282-288
Address for correspondence:
-
References
- 1 Kwak R, Kadoya S, Suzuki T. Factors affecting the prognosis in thalamic hemorrhage. Stroke 1983; 14 (04) 493-500
- 2 Weisberg LA. Thalamic hemorrhage: clinical-CT correlations. Neurology 1986; 36 (10) 1382-1386
- 3 Hankey GJ, Stewart-Wynne EG. Amnesia following thalamic hemorrhage. Another stroke syndrome. Stroke 1988; 19 (06) 776-778
- 4 Bülen þ, Omoúlu S, þahün Y, Zbakir þ. Thalamic hemorrhage (presentation and prognosis of hemorrhages). Turk J Med Sci 2001; 31: 421-423
- 5 Juvela S. Risk factors for impaired outcome after spontaneous intracerebral hemorrhage. Arch Neurol 1995; 52 (12) 1193-1200
- 6 Tatu L, Moulin T, El Mohamad R, Vuillier F, Rumbach L, Czorny A. Primary intracerebral hemorrhages in the Besançon stroke registry. Initial clinical and CT findings, early course and 30-day outcome in 350 patients. Eur Neurol 2000; 43 (04) 209-214
- 7 Bhargava P, Grewal SS, Gupta B, Jain V, Sobti H. Traumatic bilateral basal ganglia hematoma: a report of two cases. Asian J Neurosurg 2012; 7 (03) 147-150
- 8 Sarkar N, Roy BK, Das SK, Roy T, Dhibar T, Ghorai S. Bilateral intracerebral haemorrhages: an atypical presentation of Japanese encephalitis. Vol 53 JAPI; 2005
- 9 Calderon-Miranda WG, Alvis-Miranda HR, Alcala-Cerra G, M. Rubiano A, Moscote-Salazar LR. Bilateral traumatic basal ganglia hemorrhage associated with epidural hematoma: case report and literature review. Bull Emerg Trauma 2014; 2 (03) 130-132
- 10 Arboix A, Comes E, García-Eroles L. et al. Site of bleeding and early outcome in primary intracerebral hemorrhage. Acta Neurol Scand 2002; 105 (04) 282-288
![](https://www.thieme-connect.de/media/10.1055-s-00029202/20170203/thumbnails/10-1055-s-0037-1606208_00006_01.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/10.1055-s-00029202/20170203/thumbnails/10-1055-s-0037-1606208_00006_02.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)