Severe Personality Changes after Unilateral Left Paramedian Thalamic Infarct

Abstract

Personality changes are not uncommon after paramedian thalamic infarction, but usually bilateral or relatively large lesions, often complicated by other neurological or neuropsychological deficits, are present. ‘Pure’ cases of unilateral lesions are extremely rare. We report that a right-handed, 48-year-old man, who was hypertensive and diabetic but had no prior psychiatric history, developed severe personality changes and a frontal-like syndrome after recovery from acute-onset impairment of consciousness at the age of 43. Other neurological and neuropsychological disturbances, especially verbal and visual amnesia, were unremarkable. MRI showed a very small infarct in the left paramedian area of the thalamus, mainly involving the dorsomedial nucleus.

Brain Developmental Abnormalities in Prader-Willi Syndrome Detected by Diffusion Tensor Imaging

“…32 It has been suggested that abnormalities within these regions could result in psychiatric dysfunction, including personality change or bipolar disorder. 33,34 Our findings may similarly indicate that abnormalities within these regions may be responsible for the clinically observed behavioral phenotype, including psychiatric manifestations in PWS. 9 Motor dysfunction represents a main clinical feature of PWS and is considered to be primarily because of central nervous system abnormality, not muscular involvement.…”

Assessment of paramedian thalamic infarcts: MR imaging, clinical features and prognosis

“…Due to functional diachisis of the bi-directional connections of the prefrontal, orbitofrontal and anterior cingulate cortex, the clinical features of akinetic mutism and lethargic states are quite similar to those seen in lesions of frontal lobe and anterior cingulate cortex [12,14,21]. Caused by diachisis of the mamillothalamic tract (Vicq d' Azyr fibres) and the anterior part of the internal medullary lamina, severe amnesia similar to Korsakoff's psychosis may also occur as a main feature after improvement of initial hypersomnia [1,12,44].…”

“…Personality changes [14,24] artery (TTA) Anterior thalamoperforating communicating artery Intralaminar ncl. Disorientation [1,2] artery [1,2] Ventral internal Amnestic syndromes [1,2,12] Anterior thalamosubthalamic medullary lamina Apathy [21] paramedian artery [4] Mamillothalamic tract Perseverative behaviour [12] Premamillary branch of thalamotuberianpedicle [6] Inferior thalamic peduncle [7] Inferomedial Posterior Thalamoperforating pedicle [6] P1-segment of PCA Dorsomedial ncl.…”

Injury and recovery: Severe amnestic syndrome following traumatic brain injury

“…In particular, memory disorders including retrograde and anterograde amnesia are commonly reported [6,[8][9][10][11], as well as aphasia [12,13], frontal disinhibition [14], motor problems [15], severe personality changes [16,17] and hypersexuality [18].…”