Sequelae of Intracerebral Hemorrhage: The “Hardship” of Hemiparesis, Thalamic Pain, and Locked-in Syndrome, and the Limits of Recovery
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After surviving the acute phase of Intracerebral Hemorrhage (ICH), patients and their families face a long battle with its sequelae (after-effects). The type and severity of these residual deficits vary by the location of the bleeding, and Thalamic Pain, which often follows thalamic hemorrhage, is known to be the most agonizing symptom for survivors.
Sequelae of Intracerebral Hemorrhage: Summary by Location, Frequency, and Realistic Prognosis (Current as of 2025)
Bleeding Site
Main Sequelae (In order of frequency)
Status 1 Year Post-Onset (Estimate)
Impact on Daily Life
Putaminal Hemorrhage
① Hemiparesis (especially hand clumsiness) ② Sensory loss (numbness, inability to sense temp) ③ Attention deficit, apathy
* Can walk: Approx. 70% * Full hand function: Only 20–30% * Return to work with mild disability: 40–50%
★★★☆☆
Thalamic Hemorrhage
① Thalamic Pain (Burning/throbbing pain) ← The most agonizing sequela ② Generalized sensory loss ③ Memory impairment, emotional lability (uncontrollable crying/laughter)
* Can walk: Approx. 60% * Thalamic pain remains: 40–60% * Some patients become bedridden due to pain
★★★★☆
Subcortical Hemorrhage(Lobar)
① Hemi-spatial Neglect (complete neglect of one side, usually left) ② Aphasia (especially if dominant hemisphere) ③ Personality change, apathy
* Can walk: Over 80% * Return to society: Varies by location (Better if right hemisphere)
★★ ∼★★★★
Cerebellar Hemorrhage
① Ataxic Gait (walking like a drunk person) ② Slurred Speech (Dysarthria) ③ Hand tremor (inability to write)
* Almost everyone learns to walk * Many still struggle with bicycles and stairs
★★☆☆☆
Pontine Hemorrhage(Brainstem)
① Quadriparesis (paralysis of four limbs) ② Locked-in Syndrome (only eye movement possible) ③ Dysphonia + Dysphagia
* Even if they survive, bedridden/PEG tube/tracheostomy: Over 70% * Level of conversational ability: Under 10%
★★★★★
Ranking the “Real Severity” of Sequelae
Rank
Type of Sequela
Percentage of People who say “This is the worst”
Current Status of Treatment/Alleviation
1
Thalamic Pain (Burning/Electric shock pain)
Approx. 80% (of thalamic hemorrhage survivors)
Medication is effective for only about half of patients.
2
Severe Hemiparesis (Complete non-use of hand)
Approx. 60%
Improving with robotic rehabilitation and Botulinum toxin.
3
Aphasia (Especially global aphasia)
Approx. 50%
Half become conversant with intensive speech rehabilitation.
4
Hemi-spatial Neglect
Approx. 40%
Improves with prism glasses and attention training.
5
Dysphagia (Continuous choking/coughing)
Approx. 30%
Managed with swallowing rehabilitation + temporary PEG tube.
Cases Where Recovery is “Favorable” vs. “Challenging”
Favorable Recovery Factors
Challenging Recovery Factors
* Age <50 * Bleeding volume <30 mL * Right hemisphere (non-dominant side) * Rehabilitation started within the first 1–3days
* Age >70 * Bleeding volume >80 mL * Brainstem or Thalamus location * Pre-existing diabetes or dementia
Latest Sequelae Treatment and Support
Sequela
Cutting-Edge Treatment/Support Available Now
Severe Hemiparesis
① Robotic Rehabilitation (HAL, ReoGo) ② Deep Brain Stimulation (DBS: at select facilities)
Thalamic Pain
① Combination use of Milogabalin + Pregabalin ② Ketamine infusion (for refractory cases) ③ Spinal Cord Stimulation (SCS)
Aphasia
① Transcranial Magnetic Stimulation (TMS) + intensive speech training ② AI apps (language practice)
Hemi-spatial Neglect
① Prism glasses ② Visual search training software
Dysphagia
① Endoscopic swallowing surgery (e.g., vocal cord injection) ② Electrical stimulation therapy (VitalStim)
“Realistic Goal Setting” Families Should Know
Time Post-Onset
Realistic Goal Benchmark
3 Months
* Can roll over and maintain sitting balance * Can eat jelly without choking
6 Months
* Can walk with a walker * Can engage in simple conversation
1 Year
* Can walk with a cane * Can perform simple household chores (e.g., folding laundry)
Beyond 2 Years
Dramatic recovery is less likely (Goal is maintenance and adaptation)
While sequelae may “never become zero,” many people can achieve a “functional level of life” with appropriate rehabilitation and treatment.
