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A 55 year-old hypertensive man developed headache, nausea and vomiting, associated with left sided numbness which slowly worsened over 2 hours. He later became lethargic. His neurologic exam showed a dense left hemiparesis, stupor and impaired upgaze.
Axial CT scan: note - there is a large hemorrhage in the region of the right thalamus. This is a well recognized site of hypertensive intracerebral hemorrhage. With mass effect, patients develop headache, nausea and vomiting. Early neurologic symptoms are often contralateral sensory symptoms. As the lesion grows, patients may become lethargic from direct compression on the upper brainstem structures or from obstructive hydrocephalus. Eye moment abnormalities are common in thalamic mass lesions, especially impaired vertical gaze.
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