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Asian J Neurosurg. 2017 Jan-Mar; 12(1): 151–152.
PMCID: PMC5379796

Extensive traumatic thalamic contusions in a child

Sir,

Although the thalamus is one of the most commonly affected region by intracerebral hemorrhage,[1,2,3,4] simultaneous or subsequent bilateral thalamic hemorrhage is rare with only few case reports in the literature,[5,6,7,8] mainly related to hypertension,[1,3,6,9,10,11] venous thrombosis[7] or intravenous administration of tissue plasminogen activator.[8] A 16-year-old male child presented with the history of free fall from motor cycle while he was a pillion rider. He was unconsciousness since the time of injury and had multiple episodes of vomiting. He was received in the emergency department about 1 hour after the accident and at the time of presentation to the emergency he had shallow respiration. For respiratory distress, the endotracheal intubation was performed and he was kept on elective ventilation. Neurologically he was in deep coma. Glasgow coma scale was 3 (eye opening-nil, verbal response nil, motor response nil). Extraocular movements were restricted. Pupils were mid-dilated and sluggishly reacting to the light. His other general and systemic examination was unremarkable. Immediate non-contrast brain CT scan showed intracerebral hematoma in the region of the thalamus more on left side, contusion involving the splenium of the corpus callosum, intraventricular hemorrhage and small contusion involving right temporal lobe and mild cerebral edema [Figures [Figures11 and and2].2]. The child was managed conservatively; however he succumbed to his injuries.

Figure 1
CT scan brain plain showing bilateral thalamic hemorrhages
Figure 2
CT scan sagittal reconstruction showing extensive thalamic hemorrhages

The incidence of thalamic hematomas is a subgroup of hemorrhagic stroke that accounted for 1.4% of all cases of stroke and 13% of intracerebral hemorrhages[12] and the mechanisms of the hemorrhage have been well-discussed.[12,13,14] To best of our knowledge extensive traumatic thalamic hemorrhage has not been discussed. In present case, probably the mechanism for traumatic thalamic injury may probably be similar to that described in cases of hypertensive thalamic hemorrhage, i.e., acceleration-deceleration impact along the long axis of the skull causing shearing injury to perforating vessels in the thalamus.[15] In addition there would had been injury the corpus callosum against the inferior free edge of the falx cerebri leading to the contusion involving the corpus callosum seen in present case. As in the spontaneous bilateral thalamic hemorrhage, prognosis in traumatic thalamic hemorrhage is poor and depends on neurological findings, accurate calculation of the hematoma volume and size, localization of the hematoma and presence or absence of ventricular dilatation as determined.[1,5,7,10,13,14,16,17,18] As in present case, initial coma and stupor at onset have clearly been associated with fatal outcome in thalamic hemorrhages.[3,16,17,19]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1. Kwak R, Kadoya S, Suzuki T. Factors affecting the prognosis in thalamic hemorrhage. Stroke. 1983;14:493–500. [PubMed]
2. Dobato JL, Villanueva JA, Giménez-Roldán S. Sensory ataxic hemiparesis in thalamic hemorrhage. Stroke. 1990;21:1749–53. [PubMed]
3. Weisberg LA. Thalamic hemorrhage: Clinical-CT correlations. Neurology. 1986;36:1382–6. [PubMed]
4. Hankey GJ, Stewart-Wynne EG. Amnesia following thalamic hemorrhage. Another stroke syndrome. Stroke. 1988;19:776–8. [PubMed]
5. Perez J, Scherle C, Machado C. Subsequent bilateral thalamic haemorrhage. BMJ Case Reports 2009. 2009 [PMC free article] [PubMed]
6. Imai K. Bilateral simultaneous thalamic hemorrhages: Case report. Neurol Med Chir (Tokyo) 2000;40:369–71. [PubMed]
7. Erbguth F, Brenner P, Schuierer G, Druschky KF, Neundörfer B. Diagnosis and treatment of deep cerebral vein thrombosis. Neurosurg Rev. 1991;14:145–8. [PubMed]
8. Dromerick AW, Meschia JF, Kumar A, Hanlon RE. Simultaneous bilateral thalamic hemorrhages following the administration of intravenous tissue plasminogen activator. Arch Phys Med Rehabil. 199;;8:92–4. [PubMed]
9. Hirose G, Kosoegawa H, Saeki M, Kitagawa Y, Oda R, Kanda S, et al. The syndrome of posterior thalamic hemorrhage. Neurology. 1985;35:998–1002. [PubMed]
10. Steinke W, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Wolf PA, et al. Thalamic stroke. Presentation and prognosis of infarcts and hemorrhages. Arch Neurol. 1992;49:703–10. [PubMed]
11. Sáez de Ocariz MM, Nader JA, Santos JA, Bautista M. Thalamic vascular lesions. Risk factors and clinical course for infarcts and hemorrhages. Stroke. 1996;27:1530–6. [PubMed]
12. Arboix A, Rodríguez-Aguilar R, Oliveres M, Comes E, García-Eroles L, Massons J. Thalamic haemorrhage vs. internal capsule-basal ganglia haemorrhage: Clinical profile and predictors of in-hospital mortality. BMC Neurol. 2007;7:32. [PMC free article] [PubMed]
13. Imai K. Bilateral simultaneous thalamic hemorrhages: Case report. Neurol Med Chir (Tokyo) 2000;40:369–71. [PubMed]
14. Sunada I, Nakabayashi H, Matsusaka Y, Nishimura K, Yamamoto S. Simultaneous bilateral thalamic hemorrhage: Case report. Radiat Med. 1999;17:359–61. [PubMed]
15. Bahadorkhan G. Traumatic intraventricular hemorrhage in severe blunt head trauma: A one year analysis. Medical Journal of the Islamic Republic of Iran. 2006;20:13–8.
16. Barraquer-Bordas L, Illa I, Escartin A, Ruscalleda J, Marti-Vilalta JL. Thalamic hemorrhage. A study of 23 patients with diagnosis by computed tomography. Stroke. 1981;12:524–7. [PubMed]
17. Walshe TM, Davis KR, Fisher CM. Thalamic hemorrhage: A computed tomographic-clinical correlation. Neurology. 1977;27:217–22. [PubMed]
18. Kabuto M, Kubota T, Kobayashi H, Nakagawa T, Arai Y, Kitai R. Simultaneous bilateral hypertensive intracerebral hemorrhages: Two case reports. Neurol Med Chir (Tokyo) 1995;35:584–6. [PubMed]
19. Kumral E, Kocaer T, Ertübey NO, Kumral K. Thalamic hemorrhage: A prospective study of 100 patients. Stroke. 1995;26:964–70. [PubMed]

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