Classification of Spontaneous Thalamic Hemorrhagy for Management and Prediction of Prognosis

ABSTRACT

65 patients with spontaneous thalamic hemorrhage(TH) diagnosed by CT scan were treated in Catholic Medical Center. Of total 340 patients with spontaneous intracerebral hemorrhage from 1980 to 1983, TH occured in 19.1%. In order to analyse prognosis and guideline of management we classified TH into 4 types with the topographic involvement of thalamus Type I-the anteromedial TH in 3 cases(4.8%) showed no specific correlation between symptoms and site of hematoma. The prognosis was good with medical treatment alone. Type II-the posterolateral TH in 23 cases(35.2%), mainly spreaded into the internal capsule and the midbrain. Aphasia was one of the main clinical features and the prognosis was worse with both conservative and surgical treatment than those of type I and III. Type III-the dorsal TH in 26 cases(40%), often extended to the lateral ventricle and were localizing in the thalamic area. Emotional change was more occasionally indicated. Type IV-the massive TH in 13 cases(20%), was extensively involved in the thalamus and spreaded to all direction. Symptoms and signs were various and surgery was not indicated because the prognosis was poor. Aphasia was noted in the left TH, but right-hemisphere cortical dysfunction were found mainly in the right TH. The prognoses of the patients with aphaia and/or right hemisphere cortical dysfunction were poorer than those of the patients without. We consider that the patients in type II or III with aphasia and/or right-hemisphere cortical dysfunction should be managed with EVD or stereotaxic urokinase therapy for better neurological outcome.