Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK
Thalamic haemorrhage in a
teenager James Giles
MB PhD StudentThe University of Manchester, UK
Medical SchoolFoundation
Core TrainingSpecialist Training
18 23 25 27 33y
Medical School ResidencyUndergrad
Overview
•Case presentation
•Operative approaches
•Management of cavernomas
Case presentation• 13yo Asian male, previously well
• Presents with: • new sudden-onset global headache• left UE and LE “tingling”• malaise
• No significant PMH, non-contributory FH, school student, lives with parents
• Neuro: intact except subjective L hemisensory abnormality
Emergent Head CT
MR
No enhancement or feeding/draining vessels
Ozek & Ture.Childs Nerv Syst. 2002.
Benign vascular lesion and clot Consistent with cavernous malformation
POD7 - Mild LUE drift, resolved parasthesiae
Al-Holou et al. J Neurosurg Pediatr. 2012.
Cortes Vela et al. Radiology. 2012
Cavernous malformation
Asymptomatic Symptomatic
Observe
Non-resectableResectable
NeurologicalSeizuresHaemorrhage
{
Lifetime Risk = 1- (1-P)^Y
Resection risk 5%
Al-Holou et al. J Neurosurg Pediatr.
2012.
Jay et al. Br J Neurosurg. 2012; Amin-Hajani. Neurosurgery. 1998.
16 symptomatic CAs - 15-55 y.o. - 13.31Gy
3.59% annual haemorrhage rate post-gamma knife
cf 8% in Michigan case series
Harvard proton beam sig morbidity at 5y
Thanks
•Drs Sack & Levy