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Posterior cerebral artery.294, 295 The profoundly distressing dysesthesias and spontaneous pain characteristically arise days to weeks after onset. The occurrence of this syndrome after thalamic hemorrhage is variable: Alexander and LoVerme288 commented on the presence of a central pain syndrome in six of their nine patients with thalamic hemorrhage; Chung and colleagues268 reported it in one third of their patients with the posterolateral form of thalamic hemorrhage. The relative rarity of this syndrome in the setting of hemorrhage has suggested that partial thalamic lesions of a precise lateral-posterior location are necessary to produce it.295 This sensory syndrome is an uncommon feature of the usually more massive thalamic destruction due to hematoma. A second unusual sensory syndrome is a form of pure sensory stroke, classically associated with small lacunar ; thalamic infarcts.296 Small thalamic hemorrhages have occasionally presented as pure sensory stroke.297299 Thalamic hematomas of dorsal location have caused a pure hemisensory syndrome, with loss of sensation to pinprick predominating over that of vibration and joint position sense; motor strength was preserved, but coordination in the affected arm was abnormal with the eyes closed, reflecting the "sensory" rather than cerebellar character of the ataxia.297 Paciaroni and Bogousslavsky298 reported two patients with involvement of all sensory modalities affecting the face, arm, and leg contralaterally to a small hemorrhage in the center of the thalamus that involved all the ventral nuclei and the parvocellular and dorsocaudal nuclei but sparing the pulvinar. Shintani and coworkers299 reported two patients with sensory loss in the arm and leg more than the face, with contralateral lesions in either the ventral-posteriorlateral VPL ; nucleus, or the ventral-posterior-medial VPM ; nucleus; another patient with restricted "cheirooral" affecting the hand and the corner of the mouth ; dysesthesias with "burning" quality in the absence of sensory loss to superficial or deep modalities had a small hematoma in the border between the VPL and VPM. The syndrome of sensory ataxic hemiparesis has also been reported in the setting of small thalamic hemorrhages.300 The clinical presentation differed from that of lacunar ataxic hemiparesis, 301 in that the ataxia of the patients with hemorrhage corresponded to proprioceptive sensory loss, as opposed to the cerebellar character of the ataxia in lacunar ataxic hemiparesis. The hematomas were small mean volume, 7.2 mL ; , all were located in the dorsolateral thalamus, and were associated with marked impairment of proprioception but preservation of superficial sensory modalities; the associated hemiparesis was transient and predominated in the leg. The CT aspects of thalamic hemorrhage are shown in Table 13.5. Of interest are the high frequency of ventricular extension reflecting the location of the hematoma immediately adjacent to the third ventricle ; and the resulting high rate about 25% ; 274 of hydrocephalus. The mortality rate reported after thalamic hemorrhage has ranged from 25% to 52%268270 and it is closely correlated with the volume of the hematoma, level of consciousness at presentation, and presence of intraventricular hemorrhage and hydrocephalus.269, 270, 302 When comparing patients with and without intraventricular hemorrhage who were otherwise comparable in regard.
FUTURE DIRECTIONS With the support of external partners and the Select Panel, the CDC will continue to promote preconception health and care with providers, policy makers, and the public in accordance with action steps that have been agreed upon for each of the recommendations. Publishing and disseminating the recommendations will begin in 2006. Next steps will include efforts to increase awareness among public and private providers, to identify opportunities to integrate preconception care programs and policies into state, local, and community health programs, to develop tools and guidelines for practice, and to evaluate existing programs for feasibility and demonstrated effectiveness, for example, package insert. The COSHH Regulations require that a risk assessment be carried out to determine the following: can its use be avoided? the way in which glutaraldehyde is used; the precautions necessary to prevent exposure of employees and others to glutaraldehyde; the monitoring and or health surveillance required; the amount of information, instruction and training that will need to be provided.

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