Bilateral paramedian thalamic infarct: A report of five cases

Clinical study of 16 patients with thalamic infarction

“…12 In contrast, the rate of CE was high in bilateral infarction of the anterior parts. 3,4,8,11,20,23 In our case series, the frequency of SVO in patients with sensory impairments was slightly high (8/14, 57%); otherwise, the frequency of SVO was apparently high in the face/arm (5/6, 83%) group. The latter result was consistent with the previous report that the main etiology of cheiro-oral syndrome caused by thalamic infarction was SVO.…”

“…6,8,9 The neurological symptoms of "paramedian artery infarction" include decreased consciousness, vertical gaze palsy, cognitive decline, personality changes, and loss of initiative (apathy). 3,6,[8][9][10][11] Bilateral thalamic infarction frequently occurs in the region of the anteromedial part 6,8,9,11 and represents more severe behavioral deficits than that of unilateral infarction. 8 Behavioral deficits (aggressiveness, apathy, etc.)…”

“…The thalamus is supplied with multiple penetrating arteries of the posterior circulation 1–3 . The anterior part of the thalamus where the tuberothalamic artery distributes is involved in various neuropsychological deficits, such as apathy, personality changes, and impairment of recent memories 1,3–11 . Pure sensory stroke is the most frequent feature of thalamic infarction, 1,6 which is caused by low perfusion of the ventroposterior nucleus (VP) where the principal inferolateral branch originating from the thalamogeniculate branch (inferolateral artery) supplies 1–3 .…”

Good Response to Thiamine in Bilateral Thalamic Infarction Simulating a Wernicke Syndrome: Does it Has a Role in Acute Stroke?

“…On the other hand, although hypodense areas in the periaqueductal gray matter, and the medial region of the thalamus has been described in CT of patients with WS [14], how was found in our patient, segmental stenosis of the posterior cerebral artery is not a finding as it was evidenced in this clinical case. It is possible that the improvement of our patient may be due the natural evolution of some patients with BTI, described as 3 to 24 hours [5]; but we theorize that it could be related to the action mechanism of thiamine in some WS cases reports, in which dysfunction in bilateral thalamic perfusion had been found [12][13][14][15], just like patients with BTI.…”

“…One of the rarest types of stroke is bilateral thalamic infarction (BTI); with an estimated incidence of 0.6% of all strokes, and between 22%-35% of all thalamic strokes [5]; and is associated with an anatomical variant in the cerebral posterior irrigation, named Percheron´s artery [5,6]; and has some usual symptoms like depression of wakefulness, amnesia, confabulation, aphasia (if lesion is in the dominant hemisphere), apathy and agitation, among others [6]; an also paralysis of ocular motility [5]. The natural evolution of BTI is very diverse; showing cases of spontaneous resolution of symptoms in hours to days [5], secondary dementia [7,8] and death [5].…”