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NEUROIMAGES
Year : 2018  |  Volume : 66  |  Issue : 2  |  Page : 575-577

Simultaneous bilateral hypertensive thalamic hemorrhage: A rare event


Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication15-Mar-2018

Correspondence Address:
Dr. Rajveer Singh
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.227323

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How to cite this article:
Choudhary A, Goyal MK, Singh R. Simultaneous bilateral hypertensive thalamic hemorrhage: A rare event. Neurol India 2018;66:575-7

How to cite this URL:
Choudhary A, Goyal MK, Singh R. Simultaneous bilateral hypertensive thalamic hemorrhage: A rare event. Neurol India [serial online] 2018 [cited 2019 Aug 23];66:575-7. Available from: http://www.neurologyindia.com/text.asp?2018/66/2/575/227323




A 54-year old gentleman, a known hypertensive and diabetic for the last 10 years, on regular treatment, presented to our facility with sudden onset, loss of consciousness. He was found to have complete hemiplegia of the right side and facial paresis. He was a smoker and alcohol consumer; and, his initial blood pressure was 180/100 mmHg. On initial evaluation, his noncontrast computed tomography (NCCT) of the brain revealed bilateral thalamic hyperdensity, which was confirmed on magnetic resonance imaging (MRI) as hemorrhage [Figure 1]. His MR venography and angiography of the brain and neck vessels were normal. He was managed conservatively and discharged after 15 days exhibiting a Modified Rankin Scale score of 4.
Figure 1: (a) Computed tomography shows bilateral thalamic hemorrhage. (b) MRI FLAIR imaging shows bilateral subacute thalamic hemorrhage

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The majority of spontaneous intracerebral hematomas (ICHs) are associated with hypertension. Thalamic hemorrhage constitutes 6–25% of intracerebral hemorrhage in various studies.[1],[2] The most common risk factor for thalamic hemorrhage is hypertension. However, cases of bilateral thalamic hemorrhage related to hypertension are rare in literature and there are less than 15 cases reported till date [Table 1].[4-10] Although the etiopathogenesis of bilateral simultaneous hypertensive ICH is unclear, two possible mechanisms have been proposed. First, coincidental simultaneous rupture of bilateral microaneurysms or perforating arteries can cause bilateral ICHs. Subsequent rupture of bilateral microaneurysms or perforating arteries can cause multiple ICHs. The second mechanism is related to the fact that the initial hemorrhage raises the blood pressure resulting in subsequent rupture of the contralateral thalamic vessels. A hypothesis proposed by Kono et al., stated that such patients were vulnerable as they had symmetrically diseased vessels bilaterally, that had been affected simultaneously.[3]
Table 1: Cases of multiple intrathalamic and bilateral thalamic hemorrhage reported in literature

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initial will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tokgoz S, Demirkaya S, Bek S, Kasikci T, Odabasi Z, Genc G, et al. Clinical properties of regional thalamic hemorrhages. J Stroke Cerebrovasc Dis 2013;22:1006-12.  Back to cited text no. 1
    
2.
Bhaskar MK, Kumar R, Ojha BK, Singh SK, Verma N, Verma R, Chandra A, Srivastava C, Jaiswal M, Jaiswal S, Huliyappa H. A randomized controlled study of operative versus nonoperative treatment for large spontaneous supratentorial intracerebral hemorrhage. Neurol India 2017;65:752-8  Back to cited text no. 2
    
3.
Kono K, Terada T. Simultaneous bilateral hypertensive putaminal or thalamic hemorrhage: Case report and systematic review of the literature. Turk Neurosurg 2014;24:434-7.  Back to cited text no. 3
    
4.
Yi HJ, Shin IY, Hwang HS. Simultaneous multiple basal ganglia and cerebellar hemorrhage. Case report. J Cerebrovasc Endovasc Neurosurg 2013;15:316-9.  Back to cited text no. 4
    
5.
Imai K. bilateral simultaneous thalamic hemorrhages: Case report. Neurol Med Chir (tokyo) 2000; 40: 369-371.  Back to cited text no. 5
    
6.
Kohshi K, Abe H, Tsuru E. Simultaneous hypertensive intracerebral hematomas:Two case reports. J Neurol Sci 2000;181:137-9.  Back to cited text no. 6
    
7.
Sunada I, Nakabayashi H, Matsusaka Y, Nishimura K, Yamamoto S. Simultaneous bilateral thalamic hemorrhage: Case report. Radiat Med 1999;17:359-61.  Back to cited text no. 7
    
8.
Kabuto M, Kubota T, Kobayashi H, Nakagawa T, Arai Y, Kitai R. Simultaneous bilateral hypertensive intracerebral hemorrhages--two case reports. Neurol MedChir (Tokyo) 1995;35:584-6.  Back to cited text no. 8
    
9.
Lin CN, Howng SL, Kwan AL. Bilateral simultaneous hypertensive intracerebral hemorrhages. Kaohsiung J Medical Sci 1993;9: 266-75.  Back to cited text no. 9
    
10.
Hickey WF, King RB, Wang AM. Multiple simultaneous intracerebral hematomas. Arch Neurol 1983;40:519-22.  Back to cited text no. 10
    


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