Ipsilateral ptosis as main feature of tuberothalamic artery infarction

Abstract

Tuberothalamic artery infarction (TTAI) results mainly in a myriad of neuropsychological symptoms such as memory impairment, euphoria, apathy, verbal perseverations, constructional apraxia and lack of spontaneity. Language disturbances, acalculia, buccofacial and limb apraxia occur prominently after left TTAI while visual spatial processing deficits and hemispatial neglect occur prominently after the right one. Some cases of TTAI causing Horner's syndrome in addition of these wide-ranging neurobehavioral symptoms have been reported. Here, we report a case of TTAI with an ipsilateral ptosis as main clinical manifestation. This finding suggests that a Horner's syndrome can be the main feature of TTAI when neuropsychological manifestations are inconspicuous.

Anteromedial thalamic infarct: a rare presentation

“…Another recent case report of a 74-year-old woman who presented with a left eye ptosis and found to have a left anteromedial thalamic infarct was attributed by the authors to a Horner’s syndrome from extension of the lesion to the hypothalamus. However, the patient was without any associated signs or symptoms of Horner’s, and the isolated ptosis may have stemmed from the thalamic infarction 8. This finding is attributed to a disruption of the supranuclear motor circuit to the levator palpebrae.…”

Bilateral paramedian thalamic infarction with hypothalamic dysfunction

“…Normally, the TTA and the paramedian artery are two arteries responsible for the vascular supply of posterior parts of the hypothalamus where the sympathicoexcitatory tract has its origin [9]. For this reason, infarction in the hypothalamic region occurs rarely and when it happens the clinical and radiological damage is often limited [10]. In our case angio-CT scans of brain vessels revealed a bilateral filling defect in posterior communicating arteries; thus we hypothesize that in our patient the paramedian artery was responsible for blood supply to the posterior part of the hypothalamus, and its occlusion resulted in bilateral thalamic infarct with hypothalamic dysfunction.…”