Abstract:The thalamus plays an important role in different brain functions including memory, emotions, sleep-wake cycle, executive functions, mediating general cortical alerting responses, processing of sensory (including taste, somatosensory, visual, and auditory) information and relaying it to the cortex, and sensorimotor control. Thalamic stroke, both in isolation and in combination with infarcts involving other structures, are not rare. The functional complexity of the thalami nuclei and the not uncommon normal var… Show more
“…In contrast to arterial infarcts, the observed signal abnormality is primarily due to venous congestion and resultant vasogenic oedema, rather than cytotoxic oedema. The lesions are characteristically bilateral, however strikingly asymmetric in some cases [ 60 ]. Fig.…”
Section: Pathology Predominantly Affecting the Thalamimentioning
confidence: 99%
“…It has been recently found that bilateral thalamic gliomas, in contrast to their unilateral counterparts, frequently harbour mutations in EGFR oncogene, while H3K27M mutants are actually rare. Additionally, genomically tailored therapy (with tyrosine kinase inhibitors) showed encouraging results in a few paediatric patients with such bithalamic neoplasms [ 60 , 64 ].…”
Section: Pathology Predominantly Affecting the Thalamimentioning
The basal ganglia and thalami are paired deep grey matter structures with extensive metabolic activity that renders them susceptible to injury by various diseases. Most pathological processes lead to bilateral lesions, which may be symmetric or asymmetric, frequently showing characteristic patterns on imaging studies. In this comprehensive pictorial review, the most common and/or typical genetic, acquired metabolic/toxic, infectious, inflammatory, vascular and neoplastic pathologies affecting the central grey matter are subdivided according to the preferential location of the lesions: in the basal ganglia, in the thalami or both. The characteristic imaging findings are described with emphasis on the differential diagnosis and clinical context.
“…In contrast to arterial infarcts, the observed signal abnormality is primarily due to venous congestion and resultant vasogenic oedema, rather than cytotoxic oedema. The lesions are characteristically bilateral, however strikingly asymmetric in some cases [ 60 ]. Fig.…”
Section: Pathology Predominantly Affecting the Thalamimentioning
confidence: 99%
“…It has been recently found that bilateral thalamic gliomas, in contrast to their unilateral counterparts, frequently harbour mutations in EGFR oncogene, while H3K27M mutants are actually rare. Additionally, genomically tailored therapy (with tyrosine kinase inhibitors) showed encouraging results in a few paediatric patients with such bithalamic neoplasms [ 60 , 64 ].…”
Section: Pathology Predominantly Affecting the Thalamimentioning
The basal ganglia and thalami are paired deep grey matter structures with extensive metabolic activity that renders them susceptible to injury by various diseases. Most pathological processes lead to bilateral lesions, which may be symmetric or asymmetric, frequently showing characteristic patterns on imaging studies. In this comprehensive pictorial review, the most common and/or typical genetic, acquired metabolic/toxic, infectious, inflammatory, vascular and neoplastic pathologies affecting the central grey matter are subdivided according to the preferential location of the lesions: in the basal ganglia, in the thalami or both. The characteristic imaging findings are described with emphasis on the differential diagnosis and clinical context.
“…As such, insults affecting the thalamus have the potential to impact many different areas of function and cause a diverse set of deficits. The vascular supply of the thalamus includes four main arteries: the polar (tuberothalamic) artery, the inferolateral (thalamogeniculate) artery, the paramedian (thalamosubthalamic) artery, and the posterior choroidal arteries [ 2 , 12 ]. There is considerable variation in the territory supplied by each artery.…”
Section: Discussionmentioning
confidence: 99%
“…Ischemic strokes in more common locations, such as the middle cerebral artery, most often produce predictable focal neurological deficits and clinical syndromes. In contrast, the presentations of someone with an AOP infarct include altered mental status, coma, transient or episodic loss of consciousness, memory impairment, psychosis, aphasia, dysarthria, and oculomotor dysfunction [ 2 - 9 ]. When there is an acute stroke in the AOP territory, the diagnosis is often missed due to the unusual presenting symptoms and signs, as well as the fact that it may not be visualized on primary imaging.…”
The artery of Percheron (AOP) is a variant of the paramedian thalamic vasculature that supplies blood to the medial aspect of the thalamus and the rostral midbrain. The presentation of an infarct in this territory varies widely and is often characterized by nonspecific neurological deficits, with altered mental status, decreased level of consciousness, and memory impairment being among the most common. AOP infarcts are often missed on initial computed tomography (CT) scan, and additional imaging is usually not done due to low suspicion for stroke in most cases. There have been an increasing number of reports of AOP infarction, illustrating the diversity of clinical presentations and the challenge this presents to clinicians in the acute setting. Lacking the classic signs of stroke, many of these patients experience a delay in recognition and treatment, with the majority of diagnoses occurring outside the tissue plasminogen activator (tPA) window. This case highlights the unusual presentation and diagnostic difficulty of a patient with an AOP infarct, and serves as a reminder to include thalamic pathology in patients presenting with vague neurological symptoms and no obvious signs of stroke.
“…[7] Thalamic stroke is not rare, accounting for 11% of posterior circulation infarcts. [9] The thalamus plays a critical role in supporting cognitive and motor functions, managing our sensitivity to temperature, light, pain, and physical touch. It controls the flow of visual, auditory, and motor information, being also involved in different aspects of learning, memory, speech, language understanding, emotions, motivation, attention, and wakefulness, being in charge of our sense of balance and awareness of our arms and legs.…”
The aim: We aimed to determine, describe, and analyze the clinical and neuroimaging features of vascular syndromes of acute thalamic stroke in the classical vascular territories
in a prospective hospital-based cohort study.
Materials and methods: We have prospectively recruited 319 acute stroke patients, admitted to the Neurological Center at an academic hospital (Oleksandrivska Clinical
Hospital) in Kyiv, Ukraine. Complex neurological, clinical, laboratory, ultrasound, and neuroimaging examinations were performed to all study patients within 24 hours since
the symptoms onset.
Results: MRI/CT-proven thalamic stroke was diagnosed in 34 (10.6%) out of 319 patients, forming a study group. Twenty-two out of 34 patients (average age 61.9 ± 10.2
years) were diagnosed with an acute isolated ischemic thalamic stroke, and 12 patients (average age 59.0 ± 9.6 years) were diagnosed with an acute thalamic hemorrhage.
Conclusions: Specific neurological features of clinical vascular syndromes of acute thalamic stroke in the classical vascular territories were analyzed, compared, and described.
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