A Retrospective Study of Thalamic Stroke - Oren Zarif - Thalamic Stroke
There is still no definitive definition of thalamic stroke and thalamic lesions, but MRI and CT studies can give valuable insights into their distribution. However, a recent retrospective study evaluated the clinical background and etiology of this relatively uncommon type of stroke. Researchers assessed the MR diffusion-weighted imaging findings of 27 patients with thalamic stroke and the TOAST classification. This study also considered the clinical and neuropsychological outcomes.
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Most thalamic infarctions are rostral in nature and affect the anterior region of the thalamus, sparing the posterior cingulate, lateral geniculate, uncus, and internal medullary lamina. MRI findings indicate the presence of infarcts in the thalamic blood supply and a decrease in consciousness. Although there is a definite link between thalamic infarcts and the aforementioned stroke subtypes, further studies are needed to determine their exact clinical significance.
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Most thalamic infarcts are asymmetric, and the type of infarcted region most often affected is the polar artery territory. Because of this, patients with left-hemispheric strokes are more likely to be diagnosed in the hospital. Symptoms vary, but the symptoms are largely similar to those of strokes that affect the left hemisphere. This makes it difficult for clinicians to differentiate between a thalamic stroke and a right hemispheric stroke.
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The patient presented with a fluctuating consciousness and a mild twitching in one side of his face. He was diagnosed with a right thalamic paramedian infarct and arterial hypertension. Although rare, thalamic infarcts can be caused by various other conditions or structures. A thalamic infarct is associated with a central pontine artery and bilateral involvement in Wernicke encephalopathy.
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Left-hemisphere lesions typically cause language disturbances. Language is often impaired, resulting in decreased verbal output, decreased fluency, and reduced comprehension. There may be phonetic or semantic errors, but repetition and acalculia are common. If the thalamus is damaged, lesions in the thalamus may cause a thalamic hand. For this reason, this type of stroke must be carefully assessed by a neuropsychologist.
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The arteries supply the ventral posterior nuclei of the thalamus. The ventral and lateral portions of the VL nucleus are more rostral. Both parts receive input from the medial lemniscal and spinothalamic pathways. In addition, the posterior choroidal artery is involved. The arteries supplying these structures are the most common cause of thalamic stroke. These arteries are largely responsible for the development and functioning of the thalamus.
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After a thalamic stroke, recovery is largely focused on minimizing the damage and minimizing the risk of a repeat occurrence. Physical, speech, occupational, and occupational therapies are important components of recovery. The outlook for each individual varies, but recovery is a strong possibility. The recovery process can last weeks or even months. However, some symptoms of the stroke may be permanent. So, a home therapy program is essential to optimizing recovery.
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Neuropsychological tests show that thalamic lesions can have a wide variety of neuropsychological deficits, including fluctuating levels of consciousness, personality changes, and lack of spontaneity. They may also display impairments in new learning and recent memory. Patients with thalamic lesions frequently exhibit persistent thinking patterns and inappropriate maintenance of semantic categories. Additionally, speech and language abilities may be impaired. Left thalamic lesions are also associated with acalculia.
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The thalamus is an important component of the brain, as it is involved in a variety of functions, including motor function and perception of pain. If a thalamic stroke occurs, the impact on the thalamus could be severe and debilitating. The causes of thalamic stroke vary, but the most common cause is cardiac: atrial fibrillation. During this heart condition, blood clots may form in the heart, traveling to the brain and causing a stroke.
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Because the symptoms of thalamic stroke are not immediately recognizable, a subgroup of thamic stroke patients may be missed in the prehospital setting. This lack of recognition may lead to delayed stroke treatment and secondary prophylaxis. Further research is necessary to characterize the clinical features of thalamic stroke and identify the appropriate diagnostic tools. In the meantime, improved awareness of ITS symptoms may help prevent the missed diagnosis of this disease and improve the treatment process.
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Although previous studies have examined the effect of a thalamic lesion on familiarity, the results from the current study suggest that the affected brain area does not directly depend on MD. The study also suggested that familiarity does not require thalamic lesion, and it does not require any involvement of the thalamus. These results challenge our current understanding of thalamic lesions. But there is a more direct explanation for this brain damage.