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THE THALAMIC HEMORRHAGE:THE CLASSIFICATION AND THE CLINICAL PICTURES Masahiro Mizukami 1 , Hiroshi Kin 1 , Goro Araki 2 , Hiroshi Mihara 2 , Yoji Yoshida 3 1Department of Neurosurgery, Institute of Brain and Blood Vesseles, Mihara MemorIal Hospital 2Department of Neurology, Institute of Brain and Blood Vesseles, Mihara Memorial Hospital 3The Second Department of Pathology, Gunma University, School of Medicine pp.195-206
Published Date 1975/2/1
DOI https://doi.org/10.11477/mf.1406203666
  • Abstract
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34 cases with thalamic hemorrhage (8 autopsy cases and 26 clinical cases) were studied from patho-logical and angiographical standpoint, and the following conclusions were obtained.

1. The thalamic hemorrhage can be pathologically classified into 3 types:

1) Hemorrhage arising from the rupture of thamlamogeniculate artery mainly distributed in lateral nucleus. 2) Hemorrhage arising from the rupture of thalamoperforate artery mainly distri-buted in medial nucleus. 3) Hemorrhage covering the whole thalamus due to advancement of either of above hemorrhages or combining of the both.

2. Each type of the thalamic hemorrhage has characteristic findings on carotid angiogram, so can be classified also by angiography. The criteria of diagnosis were determined by elucidating the ad-vancing form of the hematoma pathologically in each type.

3. According to our diagnostic criteria, hemor-rhage in lateral nucleus is 19, hemorrhage in medial nucleus is 3 and whole thalamic hemorrhage is 12 respectively.

4. Among neurological symptoms ophthalmicsymptoms were most reliable in comatose or semi-comatose patients. These ophthalmic symptoms were myotic pupils, loss of light reflex and down-ward or wrong side deviation of eye balls as Fisher repored. However these symptoms could not be observed in patients with mild disturbance of consciousness.

5. Classical thalamic syndroms were very few and two or three symptoms of them were observed in patients with hemorrhage in lateral nucleus. So it is very difficult to diagnose as thalamic hemor-rhage in patients without severe disturbance of consciousness by neurological symptoms alone.

6. Overall mortality was 26% and the severer the disturbance of consciousness the higher the mortality was.

7. This angiographical classification of the thala-mic hemorrhage has an important meaning for the choice of the treatment and the judgement of prognosis of the thalamic hemorrhage in acute stage.

8. Ventricular drainage was the effective treat-ment for the patients with the angiographic find-ings of the internal hydrocephalus.


Copyright © 1975, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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