Thalamic hemorrhage

Introduction The thalamus is the largest oval gray matter nucleus in the interbrain, located on both sides of the third ventricle. The left and right thalamus are connected by gray matter masses (called intermediate blocks). The thalamus is closely related to the anatomy of the third ventricle and the lateral ventricle, and only the wall of the chamber is separated. Therefore, the thalamic hemorrhage often breaks into the ventricle, which can cause the lateral ventricle body to cast, or flow through the interventricular space to the third ventricle, returning to both sides. Lateral ventricle, resulting in bilateral bilateral ventricle triangle blood, and a large amount of bleeding, easy to flow into the third and fourth ventricles. Obstructive hydrocephalus is prone to occur when thalamic hemorrhage breaks into the ventricles. Thalamic hemorrhage caused obstructive hydrocephalus, the patient was comatose at the time of onset, relieved after conservative treatment of internal medicine, obstruction was relieved, and consciousness was restored. Coma at the time of onset leads to death. The amount of thalamic hemorrhage broke into the ventricles, and there were 23 cases with more than 15ml, indicating that the greater the amount of bleeding, the greater the possibility of breaking into the ventricles.

Cause

Thalamic hemorrhage is mainly caused by rupture of the cerebral geniculate artery or perforating branch. The bleeding directly invades the internal capsule, and hemiplegia often occurs.

Middle-aged and elderly people are the main population of cerebral hemorrhage. The most common age of onset is 40-70 years old. The cause of cerebral hemorrhage is mainly related to the pathological and sclerosis of cerebrovascular. Vascular lesions are closely related to hyperlipidemia, diabetes, hypertension, vascular aging, smoking, and the like. The so-called cerebral hemorrhage refers to spontaneous primary cerebral hemorrhage. Patients often have sudden onset of illness due to emotional excitement and exertion. They are characterized by aphasia and hemiplegia. The severe cases are unclear. More than half of the patients are accompanied by headache and vomiting.

The main cause of cerebral hemorrhage is chronic hypertension and arteriosclerosis. Most patients have a marked increase in blood pressure at the time of onset, leading to rupture of blood vessels and cerebral hemorrhage.

an examination

Related inspection

CT angiography scan CT contrast enhanced scan drop test pattern phentolamine block test

The clinical symptoms of thalamic hemorrhage mainly depend on whether the bleeding is confined to the thalamus, or to the surrounding adjacent area and is closely related to the amount of bleeding. For example, there are contralateral hemiplegia, partial sensory disturbance, and hemianopia, and the upper and lower limbs are basically equal, and the sensory disturbance is heavier. Individual hypothalamic pain and sensory disturbance are not easy to recover, and many unconscious obstacles extend to the shell. The weight of the nucleus is heavy, and there may be a lighter disturbance of consciousness such as lethargy. The dominant hemisphere may have a thalamic aphasia, the thalamic hemorrhage breaks into the ventricle, and the lower part of the thalamus is heavy, and there may be stress ulcers, central hyperthermia, and neurogenicity. Pulmonary edema or de-cortical rigidity, bleeding affects the midbrain can cause pupil size, nuclear oculomotor nerve paralysis and so on.

Differential diagnosis

Differential diagnosis of thalamic hemorrhage :

1. Thalamic hemorrhage can be divided into three types according to the performance of head CT. Different types of hemorrhage in the thalamus should be identified.

(1) Limitation type: the amount of bleeding is generally <10ml, limited to mild hypothalamic symptoms, multiple unconscious disorders, no complications, often dyskinesia and sensory disturbances;

(2) Thalamic basal ganglia: The hematoma invades the basal ganglia from the lateral side. The patient has severe sputum symptoms, and typical three-biased symptoms may occur. The amount of bleeding is generally >15 ml, which may have mild disturbance of consciousness;

(3) cerebral ventricle type: hematoma breaks into the lateral ventricle and the third and fourth ventricles, the amount of bleeding is generally >20ml, more conscious disturbances, severe midline shift, causing stress ulcers, central hyperthermia, pulmonary edema and other complications .

2. Thalamic hemorrhage also needs to be differentiated from other different symptoms of cerebral hemorrhage.

(1) Internal capsule bleeding: is the most common bleeding site. Its typical clinical manifestations are contralateral "three-biased" (hemiplegic, partial sensory disturbance, hemianopia). The range of internal cystic hemorrhage is large, and the symptoms of nerve damage are heavier. However, if the bleeding is biased to the outside of the internal capsule and mainly damages the outer capsule, the clinical symptoms are more mild, more unconscious, and the hemiplegia is lighter, and the prognosis is better.

(2) ventricular hemorrhage: generally divided into primary and secondary, primary ventricular hemorrhage is intraventricular choroid plexus rupture, relatively rare. Secondary is due to the large amount of intracerebral hemorrhage, piercing the brain parenchyma into the ventricles. Clinical manifestations are vomiting, excessive sweating, purple or pale skin. One to two hours after the onset, he falls into deep coma, high fever, quadriplegia or tonic convulsions, unstable blood pressure, and irregular breathing. The condition is mostly serious and the prognosis is poor.

(3) cerebral hemorrhage: also known as subcortical white matter hemorrhage, can occur in any brain lobe. In addition to headache, vomiting, bleeding in different brain lobe, clinical manifestations are also different. Such as frontal lobe hemorrhage can appear psychiatric symptoms, such as irritability, doubt, contralateral hemiplegia, sports aphasia, etc.; parietal lobe hemorrhage appears contralateral sensory disturbance; temporal lobe hemorrhage can appear sensory aphasia, mental symptoms, etc; occipital lobe hemorrhage It is most common to use hemianopia. The general symptoms of cerebral hemorrhage are slightly milder and the prognosis is relatively good.

(4) Bridge cerebral hemorrhage: The bridge brain is a good site for brain stem hemorrhage. In the early stage, the side of the disease is paralyzed, and the contralateral limb is called a cross. This is a clinical feature of cerebral hemorrhage. If the amount of bleeding is large, it will affect the contralateral side, quadriplegia, pupil dilation, hyperthermia, coma and other symptoms; if the blood breaks into the fourth ventricle, there will be serious symptoms such as convulsions and irregular breathing, and the prognosis is not good.

(5) cerebellar hemorrhage: if the amount of bleeding is small, the clinical manifestations are often first dizziness, followed by severe headache, frequent vomiting, unstable walking, unclear speech; if the amount of bleeding is large, oppress the medullary life center, severely can suddenly death.

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