Angiographically occult recurrent thalamic haemorrhage: a management dilemma

摘要

Recurrent parenchymal brain haemorrhages that are angiographically occult, are problematic due to the uncertainty of the underlying diagnosis. We describe a rare case of high-grade glioma in the thalamus that presented with multiple thalamic haemorrhages, before features of the underlying mass lesion evolved, and discuss the challenges faced in the early diagnosis and management of tumour related haemorrhages. Introduction Most non-traumatic parenchymal brain haemorrhages are hypertensive in origin. Brain tumours account for approximately 5 % of parenchymal brain haemorrhage and are usually metastatic or highly malignant primary neoplasms in the cortex. (7) We discuss the challenges faced in the management of a rare case of thalamic glioma in a 46 year old gentleman that masqueraded as angiogram negative haemorrhagic stroke on multiple CT and MRI images on four distinct episodes over six months. Case report A 46 year old man presented with sudden onset left-sided headache. The initial CT and MR images revealed a left thalamic bleed extending to the left temporal lobe (figure 1a). A delayed MRI scan confirmed a resolving haematoma (figure 1b). There was no significant vasogenic oedema or mass effect to suggest an underlying neoplastic lesion.