Thalamic Stroke - Oren Zarif - Thalamic Stroke
More left-hemispheric stroke patients are admitted to hospitals than right-hemispheric stroke patients. This may be due to selection bias, as left-hemispheric stroke symptoms are easier to recognize by patients and next of kin. Additionally, thalamic stroke patients have a broader range of symptoms, and the onset and duration of a thalamic stroke varies from patient to patient.
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MRI reveals a small infarct in bilateral thalami, and adjacent central areas of the midbrain. An axial T2 FLAIR image clearly demonstrates the infarct. The patient subsequently suffered significant impairment in left-side hemiparesis. Another characteristic of thalamic stroke is the presence of a thalamic hand. This syndrome is often caused by a lesion of the inferolateral artery.
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Another common symptom is asymmetrical ventricular extension. Although the initial neurologic syndrome does not discriminate between a unilateral tuberothalamic artery territory infarcts, the latter tends to result in more severe deficits and a higher mortality. Nevertheless, infarcts can occur in any thalamic region. Therefore, it is crucial to understand the anatomy of a thalamic stroke and how it may differ from other types of stroke.
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Although thalamic stroke is not immediately fatal, it should be treated immediately after diagnosis. The goals of rehabilitation include increasing a patient's physical and mental ability, as well as decreasing the risk of a repeat stroke. Although full recovery from a thalamic stroke can take weeks to months, patients may have permanent symptoms. In addition to the physical effects, many secondary symptoms may be permanent, such as a speech delay or double vision.
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During a study of thalamic stroke, five cases of bilateral paramedian thalamic infarctions were identified. Two of these cases included the artery of Percheron. The authors studied these five cases and reviewed the literature related to this rare diagnosis. The authors conclude that two cases of bilateral thalamic infarcts are comparable to those of top-of-basilar syndrome.
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More studies are needed to determine the specific role of the thalamus in memory and learning processes. Because thalamic structures and tracts are difficult to image, it may be difficult to use standard MRI imaging methods. In the future, dedicated structural MRI sequences may be developed for this purpose. Furthermore, patients who undergo MD may show a specific pattern of lesions in the thalamus compared to those who do not.
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A thalamic infarction can cause significant neurological deficits, including language, visual-spatial, and temporal disorientation. Left-sided lesions often result in impairment of visual, verbal, and spatial memory. Right-sided lesions are less common, but still can result in profound cognitive impairment. In addition to visual and auditory impairment, patients with right-sided lesions often experience pain syndromes.
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A thalamic infarction can cause a variety of behavioral and cognitive symptoms, including impaired memory, mood, and personality. In the acute phase, palipsychism is the predominant symptom. Other symptoms include subcortical aphasia, hemineglect, and impaired visuospatial processing. In the following, we will discuss the different types of thalamic infarction.
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A population-based MR-study can provide definitive information about the distribution of lesions within the thalamus. In addition to this, systematic neuropsychological testing is important. The study also failed to include neuropsychological tests, so it is possible to miss some cases due to inaccurate information provided by physicians. Furthermore, the lesion-overlap map should be interpreted based on the cumulative overlay of all the larger lesions in the thalamus.
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Interestingly, there is a third type of thalamic infarct. This rarer form of posterior circulation stroke accounts for a small proportion of first-ever ischemic strokes. It is estimated that approximately twenty to thirty percent of thalamic infarcts occur in this anatomical location. In this study, the posterior cerebral artery (PCA) supplies the thalamus, as well as branches from the P1 segment. Three different anatomic variants are reported, the most common of which consists of separated trunks from both P1 segments.
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A thalamic lesion can also affect behavior. The thalamus contains numerous fiber systems that connect the thalamic nuclei to other areas of the brain. Thus, lesions of fiber pathways can result in clinical phenomena. These fibers are responsible for a wide range of human behaviors. Its location in the brain is crucial for the development of our social and emotional relationships. And it also plays an important role in the development of many cognitive and motor skills.