thalamic haemorrhage in a teenager james giles mb phd student the university of manchester, uk

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Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

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Page 1: 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

Page 2: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK
Page 3: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK
Page 4: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

Medical SchoolFoundation

Core TrainingSpecialist Training

18 23 25 27 33y

Medical School ResidencyUndergrad

Page 5: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

Overview

•Case presentation

•Operative approaches

•Management of cavernomas

Page 6: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

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

Page 7: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

Emergent Head CT

Page 8: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

MR

No enhancement or feeding/draining vessels

Page 9: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK
Page 10: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK
Page 11: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

Ozek & Ture.Childs Nerv Syst. 2002.

Page 12: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

Benign vascular lesion and clot Consistent with cavernous malformation

POD7 - Mild LUE drift, resolved parasthesiae

Page 13: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

Al-Holou et al. J Neurosurg Pediatr. 2012.

Page 14: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

Cortes Vela et al. Radiology. 2012

Page 15: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

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.

Page 16: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

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

Page 17: Thalamic haemorrhage in a teenager James Giles MB PhD Student The University of Manchester, UK

Thanks

•Drs Sack & Levy