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Spontaneous thalamic hemorrhage from a lateral posterior choroidal artery aneurysm
Hitoshi Fukuda1, David Munoz, R Loch Macdonald
1Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada; Labatt Family Centre of Excellence in Brain Injury and Trauma Research Toronto, Ontario, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Background:
The authors report a case of lateral posterior choroidal artery pseudoaneurysm that caused a spontaneous thalamic hemorrhage. The case supports obtaining computed tomographic angiography (CTA) even in seemingly routine cases of hypertensive hemorrhage and demonstrates a possibly unreported type of aneurysm causing thalamic hemorrhage.
Case Description:
A 60-year-old man with a history of hypertension presented with a spontaneous right thalamic hemorrhage, and CTA showed a focus of contrast inside the hematoma. One month later, the patient was well but a CTA showed that the hematoma had resolved but that there was enlargement of the contrast-enhancing lesion in the thalamus. Catheter angiography showed an aneurysm of the lateral posterior choroidal artery. This was excised via an occipital interhemispheric supratentorial subcallosal approach. The patient recovered fully and returned to work 3 months later.
Conclusion:
The case shows the need to carefully review CTA after ICH, even in cases of seemingly typical hypertensive ICH.
