Thalamic Hemorrhage

Thalamic hemorrhage represents 10% to 15% of ICH. Overall survival in thalamic hemorrhage appears comparable to putaminal hemorrhage. In early descriptive studies, hematoma size emerged as the most important predictor of mortality. In the earliest report of the CT scan era, 18 hypertensive thalamic hemorrhages were noted; all of those with a maximum diameter > 3.3 cm were fatal, whereas the overall mortality rate was 50% (7). Other reports of a small series suggested 2.5, 3.0, and 3.3 cm as the crucial lesion diameter (8-10). In the largest series to date, Weisberg noted that no patients with maximum-diameter hematoma of < 2.5 cm died, whereas those with hematomas > 3 cm had ventricular extension, became comatose, and died. Although a precise hematoma size that results in mortality has not been defined, it is apparent that hematoma size correlates with prognosis and that patients with thalamic lesions > 3 cm in diameter rarely survive. Ventricular extension occurs in most thalamic hemorrhages and is associated with a variable prognosis, but hydrocephalus, presumably secondary to IVH, is associated with a high mortality rate (10 ).

Level of consciousness is consistently related to survival. For example, Piepgras and Rieger reported that 6 of 7 patients admitted in coma died, but 5 of 6 with an initially clear sensorium survived (11). Posterior thalamic lesions rarely result in significant permanent deficit. Complete recovery is typical with a described syndrome of posterior thalamic hemorrhage that consists of ipsilateral ptosis and miosis, contralateral sensory neglect and hemiparesis, defective pursuit toward the lesion, and hypometric saccades away from the lesion (12). Similarly, the aphasia associated with left thalamic hemorrhage usually resolves completely (10 ).

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