Thalamo-frontal Psychosis

Abstract

A 43-year-old man presented with an 18-month history of acute-onset cyclical behavioural change affecting mood, appetite, sleep, and energy levels. This had followed an initial episode of transient drowsiness which lasted 24 hours. On examination, there was some evidence of visual memory and frontal lobe deficits. A brain CT scan showed bilateral thalamic infarcts and a brain SPECT scan showed bilateral hypoperfusion of the frontal lobes. To our knowledge, this is the first reported case of thalamic infarction associated with acute-onset cyclical affective psychosis with clinical and neurophysiological features of frontal lobe syndrome. The case also highlights the possible role of thalamo-frontal circuits in the pathogenesis of the Kleine-Levin syndrome.

Apathy and executive function in Alzheimer's disease

“…Apathy commonly occurs in patients with Parkinson's disease and Huntington's disease which affect the subcortical connections of the anterior cingulate-subcortical circuit (Burns et al, 1990, Starkstein et al, 1992Stuss et al, 1988). Focal lesions of the basal ganglia (Bhatia & Marsden, 1994) and dorsolateral thalamic nucleus (Bogousslavsky et al, 1988;Guberman & Stuss, 1983;McGilchrist et al, 1993) also interrupt these circuits and produce apathy, particularly when the lesions are bilateral. In these disorders, apathy and executive dysfunction commonly co-occur although the relationship between these two phenomena has rarely been investigated.…”

Psychosis in primary angiitis of the central nervous system involving bilateral thalami: a case report

“…Thalamic involvement has been implicated in the neural basis of schizophrenia [2,3]. Neuropsychological, behavioral, and mood disruptions have also been reported in isolated cases with thalamic infarcts [4][5][6][7][8]. Here, we report a case of mass-like PACNS involving bilateral thalami presenting as schizophrenia-like psychosis in previously healthy male.…”

Behavioral and frontal cortical metabolic effects of apomorphine and muscimol microinjections into the mediodorsal thalamic nucleus

“…The findings of the present study are quite consistent with reports of cortical metabolic activity suppression in patients with focal thalamic infarcts (Casselli etal., 1991;Szelies etal., 1991). Besides this suppression of cortical metabolic activity, focal medial thalamic damage in these patients is invariably associated with disturbances of attention and memory (Bogousslavski et al, 1988;Casselli et al, 1991;Castaigne et al, 1980;Gallassi et al, 1992;Levasseur et al, 1992;McGilchrist et al, 1993;Mennemeier et al, 1992;Heilman, 1982, 1983). Thus, the results of both animal and human studies corroborate the apparent close association between suppression of MdT thalamocortical neurotransmission, attentional disturbances and frontal cortical metabolic dysfunction.…”