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