From the Guidelines
In a patient with a hypertensive left thalamic hemorrhagic CVA, you should expect muscle tone to decrease on the left side of the body, at least initially, due to the disruption of motor pathways. This is because the thalamus plays a crucial role in modulating motor function, and damage to it can lead to a decrease in muscle tone on the same side of the body as the hemorrhage. However, as the condition progresses, muscle tone on the opposite side of the body (right side) may increase due to the crossing of motor pathways in the brain and the development of post-stroke spasticity 1. The management of muscle tone in these patients is crucial to prevent complications such as contractures and pressure sores. Some key points to consider in the management of these patients include:
- Frequent assessment of neurological status using standard stroke scales such as the National Institutes of Health Stroke Scale (NIHSS) and coma scales such as the GCS 1
- Monitoring of blood pressure and cardiopulmonary function to avoid complications such as increased ICP and mass effect 1
- Use of multimodal monitoring to assess metabolic and hemodynamic variables, such as CBF, brain tissue oxygenation, and intracerebral microdialysis, to provide crucial information at the cellular level 1
- Consideration of physical therapy, positioning, range of motion exercises, and medications such as baclofen, tizanidine, or botulinum toxin injections to manage increased muscle tone and prevent complications 1.
From the Research
Muscle Tone Expectation in Hypertensive Left Thalamic Haemorrhagic CVA
- The expectation of muscle tone on the left side in a patient with hypertensive left thalamic haemorrhagic CVA is likely to decrease, as thalamic hemorrhages can cause a variety of clinical symptoms, including motor signs 2, 3.
- Studies have shown that thalamic lesions can cause forms of aphasia, such as crossed dextral aphasia, and can also affect motor function, leading to decreased muscle tone on the affected side 2, 3.
- The prognosis of thalamic hemorrhage is worse in global and medial group hemorrhages, especially those that rupture to the ventricle, which can lead to increased intracranial pressure and further damage to the surrounding brain tissue 2, 4.
- The clinical features of thalamic hemorrhage vary according to the intrathalamic location of the hematoma and the bleeding artery, with posterolateral type hemorrhages being the most frequent and having a relatively high case fatality rate 3.
- Hypertensive thalamic hemorrhage is associated with relatively small hemorrhage volume, but has a higher frequency of ventricular irruption and poor prognosis at short-term 4.
Clinical Implications
- The management of blood pressure in patients with intracerebral hemorrhage, including thalamic hemorrhage, is crucial to prevent further bleeding and improve outcomes 5.
- Nicardipine and labetalol are two commonly used antihypertensives for treating elevated blood pressures in the setting of intracerebral hemorrhage, and have been shown to be effective and safe in controlling blood pressure 5.
- Simultaneous bilateral hypertensive intracranial hemorrhage is rare, but can occur, and may be related to symmetrically vulnerable vessels 6.