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A 58 year-old hypertensive man developed headache, nausea and vomiting, associated with left sided numbness which slowly worsened over 2 hours. Over several hours, he lapsed into coma.
Axial CT scan: note - there is a large hemorrhage in the region of the right thalamus with extension to the third ventricle and anterior horn of the lateral ventricles (left scan). In addition, blood has spread into the fourth ventricle (right scan). 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.
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