Delayed Consecutive Contralateral Thalamic Hemorrhage after Spontaneous Thalamic Hemorrhage

• Published in: Journal of cerebrovascular and endovascular neurosurgery Vol. 18; no. 2; pp. 106 - 109
• Main Authors: Han, Ji Hun, Jeon, Jin Pyeong, Choi, Hyuk Jai, Yang, Jin Seo, Kang, Suk Hyung, Cho, Yong Jun
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Cerebrovascular Surgeons; Society of Korean Endovascular Neurosurgeons 01.06.2016; 대한뇌혈관외과학회
• Subjects: Case Report; 신경외과학; Hypertension; Thalamus; Intracranial hemorrhages
• ISSN: 2234-8565; 2287-3139
• DOI: 10.7461/jcen.2016.18.2.106

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.