Hematomas talámicos: etiología, clínica y pronóstico

Abstract

The appearance of new neuroimaging techniques has permitted study of large series of thalamic hematomas, amongst which differences have been observed according to the size and arterial territory affected. To determine the existence or not of differences between thalamic hematomas, according to their arterial territory and size, with regard to the aetiology, clinical findings and short term prognosis. A retrospective study was made of 60 patients admitted to hospital with the diagnosis of thalamic hematoma (between January 1987 and July 1997) classified according to localization as: anterior, dorsal, posterolateral, posteromedial and global, and according to size as: large (> 20 mm), and small (< 20 mm) in which we analyzed the aetiology, clinical signs and prognosis up to discharge from hospital. The commonest aetiology was found to be arterial hypertension (60%); with regard to the arterial territory involved we have observed different clinical and prognostic features but the number of patients in each group was too small to permit statistical analysis. Significant differences were shown with regard to the size of the hematoma: large hematomas more often extended to nearby structures, caused hydrocephalia, were associated with alteration in the level of consciousness, severe motor deficit, oculomotor changes, alteration in superior functions and hemianopsia, and had worse prognosis and increased mortality and dependence in everyday activity than small hematomas. According to their size, thalamic hematomas show statistically significant clinical and prognostic differences.