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 StudentThe University of Manchester, UK
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Medical SchoolFoundation
Core TrainingSpecialist Training
18 23 25 27 33y
Medical School ResidencyUndergrad
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Overview
•Case presentation
•Operative approaches
•Management of cavernomas
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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
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Emergent Head CT
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MR
No enhancement or feeding/draining vessels
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Ozek & Ture.Childs Nerv Syst. 2002.
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Benign vascular lesion and clot Consistent with cavernous malformation
POD7 - Mild LUE drift, resolved parasthesiae
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Al-Holou et al. J Neurosurg Pediatr. 2012.
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Cortes Vela et al. Radiology. 2012
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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.
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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
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Thanks
•Drs Sack & Levy