Infarct thalamic

Kuker W, Weise J, Krapf H, Schmidt F, Friese S, Bahr M (2002) MRI characteristics of acute and subacute brainstem and thalamic infarctions value of T2- and diffusion-weighted sequences. J Neurol 249 33-42... 

Kuker et al. (2002) 45 Clinical symptoms of akute infratentorial or thalamic infarction Sensivity of DWI and T2 is lower earlier than 12 h after onset and for medulla-oblongata lesions... 

There are three parietal MCA branches anterior, angular and posterior. Anterior parietal or postcentral sulcus artery infarct causes a contralateral sensory loss, with upper limb predominance (pseudo-thalamic syndrome) with involvement of the touch, pain, temperature and vibration senses. Pain and hyperpathia and parietal ataxia can also be present. Conduction aphasia, which is a fluent form of aphasia with disproportionate impairment of repetition, anomia, agraphia and apraxia are present in left hemispheric infarcts while neglect follows in right hemispheric ones. 

Fig. 14.2. Complete right posterior cerebral artery (PCA) territorial infarct.Notice the anterolateral mesencephalic and the inferolateral thalamic infarcts. Old left striatocapsular infarct...

Cerebellar infarcts can be grouped in territorial (superior cerebellar artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery and combined), borderzone and lacunar. They are often combined with brain stem infarcts and with superficial posterior cerebral artery or thalamic infarcts. The most common isolated cerebellar infarcts are located in the superior cerebellar artery and posterior inferior cerebellar artery territories (Amarenco 1993 Amarenco et al. 1993,1994). 

Bogousslavsky J (1993) Subcortical infarcts. In Fisher M, Bogousslavsky J (eds) Current review of cerebrovascular diasease. Current Medicine, Philadelphia, pp 31-40 Bogousslavsky J, Caplan LR (1993) Vertebrobasilar occlusive disease review of selected aspects. 3 thalamic infarcts. Cerebrovasc Dis 3 193-205... 

Cambridge University Press, Cambridge Bogousslavsky J, Regli F, Uske A (1988) Thalamic infarcts clinical syndromes, etiology and prognosis. Neurology 38 837-848... 

Kumral E, Evyapan D, Balkir K et al (2001) Bilateral thalamic infarction. Clinical, etiological and MRI correlates. Acta Neurol Scand 103 35-42... 

Brainstem, cerebellar, thalamic or occipital lobe signs normally indicate infarction in the distribution of the vertebrobasilar circulation or a localized hemorrhage. 

Small thalamic lesions may cause a pure sensory stroke or sensorimotor stroke, sometimes with ataxia in the same limbs (Schmahmann 2003). However, other deficits may occur in isolation, or in combination depending on which thalamic nuclei are involved. These include paralysis of upward gaze, small pupils, apathy, depressed consciousness, hypersomnolence, disorientation, visual hallucinations, aphasia and impairment of verbal memory attributable to the left thalamus, and visuospatial dysfunction attributable to the right thalamus. Occlusion of a single small branch of the proximal posterior cerebral artery can cause bilateral paramedian thalamic infarction with severe retrograde and anterograde amnesia. 

Fig. 10.3. Images with T2-weighted (a) and diffusion-weighted (b) MRI in a 70-year-old man who presented with a history of sudden-onset numbness and tingling in the left face arm and leg. On examination there was sensory loss over the left hand but nothing else. The diffusion-weighted images confirm a thalamic infarct consistent with the clinical diagnosis of pure sensory stroke.

Fig. 10.7. Use of T2-weighted and diffusion-weighted (DWI) MRI. (a) A patient without vascular risk factors presented with a history of transient left arm and facial weakness 10 days earlier. The T2-weighted image (left) is normal but DWI (right) shows an acute right parietal infarction (arrow), (b) A patient presented with a history of transient right arm and facial weakness and sensory loss nine days before presentation. The T2-weighted image (left) is normal but the DWI (right) shows an acute left thalamic infarction (arrow).

Pradalier A, Lutz G, Vincent D. Transient global amnesia, migraine, thalamic infarct, dihydroergotamine, and sumatriptan. Headache 2000 40(4) 324-7. 

Yamada, K., Kinoshita, A., Kohmura, E., Sakaguchi, T., Taguchi, J., Kataoka, K. and Hayakawa, T. (1991) Basic fibroblast growth factor prevents thalamic degeneration after cortical infarction. J. Cerebral Blood Flow Metab. 11 472-478. 

Fig. 7.8 Thalamic lacune without an acute DWI abnormality. Forty-five-year-old female with patent foramen ovale. Initial DWI and ADC images demonstrate no definite acute infarction.

Follow-up FLAIR image demonstrates a punctate hyperintense left thalamic lacunar infarction (white arrow)... 

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