A 52 year-old hypertensive man developed headache, nausea and vomiting, associated with right sided numbness which slowly worsened 30 minutes. Right sided weakness then developed followed by a decreased level of alertness.

Axial CT scan: note - there is a large hemorrhage in the region of the left thalamus with extension to the lateral ventricle. This is a common 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. 

Revised 05/04/06.
The Electronic Curriculum is copyrighted 1998,  Case Western Reserve University School of Medicine.