Vascular Syndromes of the Thalamus

Abstract

Background-This article reviews the anatomy, connections, and functions of the thalamic nuclei, their vascular supply, and the clinical syndromes that result from thalamic infarction. Summary of Review-Thalamic nuclei are composed of 5 major functional classes: reticular and intralaminar nuclei that subserve arousal and nociception; sensory nuclei in all major domains; effector nuclei concerned with motor function and aspects of language; associative nuclei that participate in high-level cognitive functions; and limbic nuclei concerned with mood and motivation. Vascular lesions destroy these nuclei in different combinations and produce sensorimotor and behavioral syndromes depending on which nuclei are involved. Tuberothalamic territory strokes produce impairments of arousal and orientation, learning and memory, personality, and executive function; superimposition of temporally unrelated information; and emotional facial paresis. Paramedian infarcts cause decreased arousal, particularly if the lesion is bilateral, and impaired learning and memory. Autobiographical memory impairment and executive failure result from lesions in either of these vascular territories. Language deficits result from left paramedian lesions and from left tuberothalamic lesions that include the ventrolateral nucleus. Right thalamic lesions in both these vascular territories produce visual-spatial deficits, including hemispatial neglect. Inferolateral territory strokes produce contralateral hemisensory loss, hemiparesis and hemiataxia, and pain syndromes that are more common after right thalamic lesions. Posterior choroidal lesions result in visual field deficits, variable sensory loss, weakness, dystonia, tremors, and occasionally amnesia and language impairment. Conclusions-These vascular syndromes reflect the reciprocal cerebral cortical-thalamic connections that have been interrupted and provide insights into the functional properties of the thalamus.

Human thalamus contributes to perceptual stability across eye movements

“…The affected portions of central thalamus closely correspond to homologous portions of primate thalamus in which saccade-and eye positionrelated signals have been recorded previously (13,17). Although single lesions affecting the thalamus are occasionally encountered in larger cohorts of stroke patients (18), oculomotor abnormalities and other neurological and cognitive deficits are observed in the vast majority of these patients (14,19). Screening of the medical records and imaging databases in our department (>2,000 stroke patients/year) yielded no further subjects with unilateral lesions of similar selectivity in our thalamic region of interest.…”

Cognitive dysfunction associates with white matter hyperintensities and subcortical atrophy on magnetic resonance imaging of the elderly diabetes mellitus Japanese elderly diabetes intervention trial (J‐EDIT)

“…The thalamus is recognized to be associated with cognitive functions such as learning, memory and executive function [32,40]. The parietal lobe constitutes association areas that are the sites of cortical integration for all behavior such as vision, body awareness and spatial orientation and for abstract and complex cognitive functions.…”

Artery of percheron infarction: case reports and literature review

“…4,5 Various other series have reported the incidence of AOP infarcts to be 2% of all strokes to 4-18% of thalamic strokes. 6 In a large series of B/L thalamic infarcts by Lazarro et al, the commonest pattern of involvement was paramedian thalamic infarction with rostral midbrain infarct. 7 The same pattern was observed in cases 1 and 3.…”

“…6,8 AOP infarcts are usually identified on MRI brain sequences that show characteristic B/L thalamic paramedian lesions with or without involvement of the mid brain. Lazarro et al described a distinct pattern of Vshaped hyperintensity on axial FLAIR and/or DWI sequences along the pial surface of the midbrain adjacent to the interpeduncular fossa in 67% of patients with midbrain involvement.…”