Hypertensive Thalamic Hemorrhage Research Articles

Non-Occlusive Mesenteric Ischemia associated with Hypertensive Thalamic Hemorrhage : A Case Report

78歳男性, 精神科入院中に左視床出血を発症し当科へ転科した. 転科後不明熱が続き, 脳出血発症14日目に上部消化管出血を併発し, 19日目に腹部膨満, 嘔吐後ショック状態となった. 腹部造影CTで非閉塞性腸管虚血 (NOMI) を疑い, 緊急開腹手術で壊死した小腸を切除し小腸の端々吻合を行った. 術中および病理所見よりNOMIと診断した. 手術後36日目に経口摂取可能となり, リハビリテーション病院へ転院した.

Exploration of the clinical effect of 3D printing assisted prefrontal puncture in the treatment of hypertensive thalamic hemorrhage breaking into the ventricle.

article: Exploration of the clinical effect of 3D printing assisted prefrontal puncture in the treatment of hypertensive thalamic hemorrhage breaking into the ventricle - Minerva Medica 2022 August;113(4):749-51 - Minerva Medica - Journals

California Institute Of Behavioral Neurosciences & Psychology

California Institute Of Behavioral Neurosciences & Psychology

Hypertensive thalamic hemorrhage: analysis of short-term outcome

Background: Hypertension is the main cause of intracerebral hemorrhage with a thalamic location frequency that varies from 6% to 26.5%.Objective: We aimed to identify clinical and radiological features that could impact the short-term prognosis in patients with hypertensive thalamic hemorrhage (HTH).Methods: Consecutive patients presenting to a tertiary referral hospital with HTH were analyzed from 2010 to 2014. Clinical features at emergency department and a 30-day outcome using the modified Rankin Scale (mRS) were obtained.Results: A total of 104 patients were studied (53 women, mean age 68.2 years, range 27–91 years), 91 (87.5%) of them with hypertension history. Mean hemorrhage volume was 12.2 mL (range 2–45 mL), without significant differences according to gender or age group. Irruption into the ventricular system occurred in 79 (76%) cases. Thirty-day mortality was 38.5% and occurred with a higher frequency in men, in patients with GCS <8, intraventricular irruption, ventriculostomy, and intracerebral hemorrhage volumes >15 mL.Conclusions: Although HTH is associated with relatively small hemorrhage volume, it had a higher frequency of ventricular irruption and bad prognosis at short-term.

The experience of craniotomy versus minimally invasive surgery in treatment of hypertensive thalamic hemorrhage

The experience of craniotomy versus minimally invasive surgery in treatment of hypertensive thalamic hemorrhage

Comparative analysis of four different treatments for hypertensive thalamic hemorrhage

One hundred and twenty patients with hypertensive thalamic hemorrhage were treated by different methods according to clinical situation and patients or family members. In this study 33 patients died: 7 patients were treated with conservative therapy, 6 patients with bilateral ventricle drainage, 8 patients with bilateral ventricle drainage plus hematoma puncture and aspiration, 12 patients with hematoma evacuation and decompressive cranioectomy. Comparison between different treatments revealed a statistically significant difference (P < 0.05). The treatment for hypertensive thalamic hemorrhage should be treated by different methods according to various clinical conditions to obtain better outcome. DOI：10.3969/j.issn.1672⁃6731.2012.04.020

Cubic oriented stereotactic hematoma aspiration combined with urokinase and dexamethasone in treatment for hypertensive thalamic hemorrhage (report of 65 cases)

Objective To investigate the clinical results and significance of aspirating hypertensive thalamic hemorrhage by cubic oriented stereotactic hematoma aspiration combined with urokinase and dexamethasone.Methods The clinical experience of hypertensive thalamic hemorrhage of 65 cases treated with cubic oriented stereotactic hematoma aspiration combined with urokinase and dexamethasone was retrospectively analyzed.Cranial CT scan was used to survey the volumes of hematomas and encephaledema.Results Hematoma volume was evacuated more than 95％ during 24 hours post-operation in 19(29.2％),more than 95％ during48 hours post-operation in 42(64.6％); one month after the operation,GOS score achieved 4～5 in 48 patients (73.8％),and the mortality was 0.15％.Conclusion Cubic oriented stereotactic hematoma aspiration combined with urokinase and dexamethasone can be applied at the bedside with accurate location,high efficacy and safety,easy operation,speeding the clearance of hematoma,and decreasing encephaledema. Key words: Hypertension; Intracerebral hemorrhage; Stereotaxic techniques; Urokinase; Dexamethasone

The transylvian trans-insular approach to lateral thalamic lesions

Thalamic tumors are rare intracranial tumors. The most common approaches to the thalamus have been directed through the ventricular system, which surrounds it. The transsylvian trans-insular approach to the lateral thalamus has been infrequently described probably because of the vulnerability of the internal capsule, which skirts this part of the thalamus. To describe the approach emphasizing its anatomical basis and also to evaluate its safety and efficacy. Retrospective study conducted at a tertiary hospital. Patient population included all the patients who underwent surgery for the lesions in lateral thalamus using the transylvian trans-insular approach between 2005 and 2011. A trephine craniotomy was made, centered over posterior sylvian fissure and the surgical corridor was developed through the insular cortex. During the study period 10 patients (7 tumors and inflammatory lesions and 3 hypertensive bleeds) were treated using this approach. One peri-operative mortality was noted. In patients with lesions other than hypertensive thalamic hemorrhage, there was no postoperative worsening of neurological deficit as comparative to preoperative deficits. Total excision/evacuation of the lesion could be accomplished in all the patients. The transylvian trans-insular approach is safe, effective, anatomical procedure, and can be performed at a peripheral center without the need for navigation and intra-operative monitoring.

Analysis of treatment and efficacy of hypertensive thalamic hemorrhage

Objective To investigate the treatment strategies, efficacy and surgical indications of hypertensive thalamic hemorrhage.Methods A retrospective analysis of the clinical data of 137 cases with hypertensive thalamic hemorrhage (HTH) from January 2008 to January 2010 in West China Hospital of Sichuan University were performed to compare the efficacy and prognosis between surgical treatment group and conservative treatment group.Results Of the 137 patients, 62 patients underwent surgery and 75 patients receivedconservative treatment.In small hematoma group, 22 patients underwent borehole and drainage and 55 cases received conservative treatment.In large hematoma group, 40 patients received craniotomy to remove Key words: Hypertension; Thalamic hemorrhage; Treatment

Basilar Apex Aneurysm Manifesting as Third Ventricular Mass and Obstructive Hydrocephalus -Case Report-

A 58-year-old male, with a past history of hypertensive thalamic hemorrhage 12 years before, presented with gradually exaggerating gait disturbance, memory disturbance, and urinary incontinence. On admission, he had gait disturbance represented by petit pas and anteropulsion in addition to significant recent memory disturbance. Cranial computed tomography (CT) revealed a hyperdense mass in the third ventricle with triventricular dilation. Cerebral magnetic resonance (MR) imaging and MR angiography identified the third ventricular lesion as saccular basilar apex aneurysm. No other intracranial abnormal intensity contributing to his clinical symptoms was recognized. Cervical MR angiography showed normal findings. Cerebral blood flow (CBF) measurements revealed diffuse CBF reduction in the cerebral hemisphere. The patient underwent coil embolization which accomplished complete aneurysm occlusion. He showed only slight improvement in his gait disturbance after embolization, and CT following embolization revealed persistent ventriculomegaly. Ventriculoperitoneal shunting was carried out. Intraoperative neuroendoscopy demonstrated cerebrospinal fluid (CSF) obstruction caused by the embolized aneurysm at the level of the third ventricle, with normal CSF findings. Postoperatively his gait disturbance and intellectual impairment showed remarkable improvement. Basilar apex aneurysm associated with obstructive hydrocephalus has complex underlying pathology and should be treated by a combination of definitive aneurysm obliteration and CSF diversion.

Factors affecting the prognosis in thalamic hemorrhage.

The present study deals with the factors affecting the prognosis in the acute stage of 29 cases with hypertensive thalamic hemorrhage diagnosed by CT scan. It was thought that the following factors were significantly related to the outcome of the patients who were unable to lead daily life, remained in vegetative state or died: (1) consciousness level was below 10 in the so-called 3-3-9 formula, (2) bilateral Babinski's signs were observed, (3) localization of the hematoma was all the thalamic nuclei type, (4) hematoma volume was above 10 ml, (5) the maximum dimension of hematoma was over 30 or 35 mm, maximum width over 30 mm, maximum length over 25 mm and maximum height over 30 or 40 mm, and (6) the ventricles were dilatated. The prognosis had no significant relationship with the age of the patients, the side of the hematoma, the presence or the absence of ventricular penetration of the hematoma, or the existence of midline shift. We believe that in the acute stage of hypertensive thalamic hemorrhage, the prognosis can be forecasted by neurological findings, accurate calculation of the hematoma volume and size, localization of the hematoma and presence or absence of ventricular dilatation as determined by CT scan.