A 45-YEAR-OLD man with a history of hypertension, poor compliance with medications, old subcortical strokes, and chronic renal insufficiency had hemiparesis, respiratory distress, agitation, and severe hypertension (240/118 mm Hg). An examination revealed decreased alertness, mutism, preserved ability to follow simple commands, bilateral hyperreflexia, and right hemiparesis involving the face. Initial computed tomography of the brain revealed a small left diencephalic (predominantly thalamic) intracerebral hemorrhage of approximately 3 mL, with mild mass effect in the third ventricle and no evidence of increased intracranial pressure or diffuse edema (Figure 1A). Despite the unchanged hemorrhage size, the patient's confusion and autonomic instability progressed. He underwent ventriculostomy, and his intracranial pressure was normal.
Gondim FAA, Leacock RO. Subconjunctival Hemorrhages Secondary to Hypersympathetic State After a Small Diencephalic Hemorrhage. Arch Neurol. 2003;60(12):1803-1804. doi:10.1001/archneur.60.12.1803