In six patients with CT evidence of posterior thalamic hemorrhage, we found the following signs: saccadic hypometria away from the lesion; defective pursuit toward the lesion with corresponding opticokinetic abnormalities; mild ipsilateral ptosis; ipsilateral miosis; unilateral sensory neglect; and sensorimotor hemiparesis. This distinct syndrome has a benign course and satisfactory recovery. It differs from the classic picture of thalamic hemorrhage, and can be called "the syndrome of posterior thalamic hemorrhage."
A 57-year-old man presented with a pulmonary mass and subacute onset of paraplegia. Laboratory examination revealed an increased protein content in the cerebrospinal fluid and a normal myelogram. Autopsy disclosed epidermoid carcinoma in the left lower lobe of the lung, intramedullary metastasis at the midthoracic level, and a central pencil-shaped softening above and below the metastatic lesion. The pencil-shaped softening was an ischemic infarct rather than of hemorrhagic or congestive origin. The pathogenesis of this rare association may be explained by the hypothesis of a tumor embolus in the arterial circulation that feeds the center of the cord, producing metastasis. This embolus was followed later by a second embolus to a radicular artery, causing the pencil-shaped softening of the spinal cord.
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