Thalamic stroke

Ferrante FM, Rana MV, Ferrante MA (2004) Conversion disorder mimicking Dejerine-Roussy syndrome (thalamic stroke) after spinal cord stimulation. Reg Anesth Pain Med 29 164-167... 

Thalamic stroke should be considered when there is a sudden onset of behavioral disturbance. The diagnosis is often missed since patients are thought to have primary psychiatric disorders, especially when neurological dysfunction is lacking. Distinct behavioral patterns can be delineated on the basis of the four main arterial thalamic territories (Schmahmann 2003 Carrera and Bogousslavsky 2006) ... 

A 59-year-old man who is s/p thalamic stroke 3 months ago is seen in the clinic and reports continual pain in the contralateral jaw and leg. The pain is burning and marked by tingling, particularly in the knee. He also reports a hypersensitivity of the leg when long pants are worn. He tried gabapentin 100 mg TID for 2 weeks but did not feel improvement and is now asking to try another medication. Which of the following options is most appropriate. 

Biller J, Sand JJ, Corbett JJ et al (1985) Syndrome of the paramedian thalamic arteries clinical and neuroimaging correlation. J Clin Neuroophthalmol 5 217-223 Bladin CF, Chambers BR (1994) Frequency and pathogenesis of hemodynamic stroke. Stroke 25 2179-2182 Bogousslavsky J (1994) Frontal stroke syndromes. Eur Neurol 34 306-315... 

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.

Gastric ulceration and hemorrhage Central post-stroke "thalamic" pain... 

Post-stroke, or thalamic, pain is a burning, severe and paroxysmal pain exacerbated by touch and other stimuli. Such post-stroke pain is rare and usually occurs weeks or months after stroke (Nasreddine and Saver 1997 Frese et al. 2006). There are usually some sensory signs in the affected areas. The lesion is usually located in the contralateral thalamus but may lie elsewhere in the central sensory pathways. Treatment includes anticonvulsants, amitriptyline and various sorts of counter-stimulation but is often unsuccessful. 

Binkofski F, Seitz RJ, Arnold S et at (1996). Thalamic metabolism and corticospinal tract integrity determine motor recovery in stroke. Annals of Neurology 39 460-470 Blennerhassett J, Dite W (2004). Additional task-related practice improves mobility and upper limb function early after stroke ... 

Pappata S, Levasseur M, Gunn RN, Myers R, Crouzel C, Syrota A, Jones T, eutzberg GW, Banad RB (2000) Thalamic microglial acdvadon in ischemic stroke detected in vivo by PET and [11C]PK1195. Neurology 55 1052-1054. 

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