Bilateral Thalamic Lesions

Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD 20814, USA.
American Journal of Roentgenology (Impact Factor: 2.73). 03/2009; 192(2):W53-62. DOI: 10.2214/AJR.08.1585
Source: PubMed

ABSTRACT OBJECTIVE: The purpose of this study was to present the neuroimaging findings and differential diagnosis of bilateral thalamic lesions. CONCLUSION: The limited differential diagnosis of bilateral thalamic lesions can be further narrowed with knowledge of the specific imaging characteristics of the lesions in combination with the patient history.

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    • "Sensory symptoms that may appear as harmless may easily be ignored, but acute sensory symptoms defined with a remarkable midline split, especially when both head and trunk are involved, is often considered unique to thalamic or thalamocortical lesions [9], and augur a minor stroke. Bilateral thalamic lesions are in general uncommon [10]. However, bilateral paramedian thalamic infarcts, due to occlusion of the artery of Percheron, are well known [11], but lateral ‘mirror lesions’ as seen in the present patient must be considered very rare. "
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    ABSTRACT: Introduction Patients often complain about sensory symptoms that appear to the doctor as harmless, and reassurances are often given. Sensory strokes may easily be ignored. Case presentation A 48-year-old Caucasian woman with insulin-dependent diabetes and hyperlipidemia experienced symptoms that progressed within hours to a complete left-sided hemisensory syndrome. This was caused by a lacunar infarct in the ventral posterior tier nuclei of the right thalamus. A few days later she gradually developed an almost identical, but incomplete hemisensory syndrome on the opposite side caused by a corresponding lacune in the left thalamus. Severe persistent and paroxysmal pain on both sides of the body became disabling. Conclusion Small strokes only affecting the somatosensory system should not be underestimated. Neuropathic pain may result. Probably unique in the present case is the demonstration of bilateral thalamic pain secondary to two almost identical thalamic infarcts. Small vessel disease (microatheroma or lipohyalinosis) was the most likely cause of the lacunes. One can only speculate if there was an occlusion in two separate thalamic perforators, or in a single dominant artery supplying the bilateral thalami.
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