Thalamic Stroke - Oren Zarif - Thalamic Stroke

A thalamic stroke occurs when the brain fails to process information correctly. It is associated with speech and language deficits, decreased verbal output, and difficulty in comprehension and fluency. Patients with left thalamic lesions may also exhibit hypophonic speech and make semantic and phonetic errors. Repetition, however, is well preserved. Some patients may also exhibit acalculia. Nevertheless, these findings do not prove that a thalamic stroke is an uncommon condition.

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The cause of a thalamic stroke is still largely unknown. The most common forms of the disease are polar artery territory infarction and thalamic infarction. A thalamic stroke may be a result of another type of infarction, such as an ischemic brain tumor. Fortunately, thalamic strokes are rare, but it is not unheard of.

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One case report describes a young Caucasian man who was admitted to the emergency department with symptoms of fluctuating consciousness, visual impairment, hemi-ataxia, and arterial hypertension. Though thalamic infarction is not a common cause of stroke, the patient's symptoms are usually related to the other structures or metabolic disorder. However, infarction in the left thalamus is associated with a variety of symptoms, including visual field defect, facial paresis, and verbal memory loss.

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A population-based MRI-study can provide definitive insights into the pattern of thalamic lesions. However, the data obtained in this study do not include neuropsychological testing, which may have missed neuropsychological deficits in some patients. A lesion-overlap map should also be interpreted based on the cumulative overlap of all larger lesions in the center of the thalamus. Once a thalamic stroke is diagnosed, treatment should focus on recovery, rehabilitation, and prevention of a thalamic stroke.

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Patients with left polar thalamic infarction often exhibit persistent and varying levels of consciousness, lack of insight, and spontaneity. They may also experience impairment in recent memory and in learning. Moreover, patients with right thalamic lesions are more likely to suffer from pain syndromes. Acute thalamic lesions can lead to global amnesia and reduced arousal. They can also cause acalculia, which is a condition where the brain does not process memory properly.

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Two arteries supply several thalamic nuclei. The P1 Cerebral Posterior artery reaches the anterior thalamic nucleus. The P2 branch of the posterior cerebral artery supplies the ventral part of the VL nucleus. The ventroposterolateral nucleus receives inputs from the spinothalamic and medial lemniscal pathways.

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Though acute thalamic infarcts can produce a wide range of movement disorders, a disproportionate number of patients with the condition also exhibit delayed movement disorders. In contrast, cerebral plasticity causes the disorder to be delayed. Some patients recover from an acute thalamic infarct in their hand, but the tremor returns years after the stroke. In other cases, the condition is associated with aberrant connections that generate abnormal involuntary movements.

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The role of the MD is increasingly recognized in the prevention of thalamic stroke. However, this information must be validated with a neuropsychological approach based on accurate lesion reconstructions. This study evaluated patients with left ischemic thalamic stroke. In cases where MTT was damaged, the patients showed variable loss of recollection and familiarity. However, cases with MD did not have any MTT damage, indicating that familiarity is spared.

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The prehospital setting may not identify this subgroup. The symptoms of this type of stroke may be less obvious and may not receive proper treatment in time. This study focused on the clinical symptoms in isolated thalamic stroke patients and left-right lateralization patterns to help identify potentially missed stroke patients. It will also help clinicians identify the specific type of thalamic stroke a patient is experiencing. Once recognized, a thalamic stroke may require specialized treatment.