Multiple variant type thalamic infarcts: pure and combined types

Kumral, Emre; Deveci, Emrah Emre; Çolak, Ayşe; Çağında, Ayşe D.; Erdoğan, Can

doi:10.1111/ane.12290

Cited by 15 publications

(11 citation statements)

References 47 publications

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“…They reported the distribution of affected variant territories such as the anteromedian (n=9), posterolateral (n=8), and central (n=4). In present study, the most frequently affected variant territory was posterolateral, consistent with results of Kumral et al (7). However, the least frequently affected variant territory was anteromedian, contrary to the findings of Carrera et al (2).…”

Section: Discussionsupporting

confidence: 89%

Topographic Evaluation of Acute Isolated Unilateral Thalamic Infarctions on Diffusion-weighted Imaging

Doğan¹

2020

jarem

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The thalamus plays a major role in regulating arousal, consciousness, and activity. Distinct vascular distribution of the thalamus causes different syndromic presentations of thalamic nuclei infarctions. During the evaluation of acute thalamic infarction, it is important to determine the thalamic vascular zone that is affected. This study aimed to assess the topography of acute isolated unilateral thalamic infarction on diffusionweighted imaging, and to investigate the distribution of classic and variant type thalamic infarctions. Methods: The imaging database of the 336 consecutive patients with acute thalamic infarction admitted to the radiology department between January 2015 and February 2020 were retrospectively reviewed. Specifically, patients with acute isolated unilateral thalamic infarction were included. The most affected thalamic territory, variant/classical territory rates, and the comparison of age and gender were evaluated. Results: A total of 141 patients (classic territory group: 104, variant territory group: 37) were reviewed. The ratio of affected classic territory to variant territory was 2.8. Affected classic territories were inferolateral (n=68), anterior (n=25), paramedian (n=11), and posterior (n=0). Affected variant territories were posterolateral (n=18), central (n=13), and anteromedian (n=6). Comparing the patients in both groups, age, sex, and side were similar, p=0.435, p=0.71, and p=0.85, respectively. Relevant arteries did not have stenosis in 96.2% of patients, and no significant difference was observed between both groups, p=0.631. Conclusion: In isolated acute unilateral thalamic ischemia, the ratio of the affected variant to the classic territory was approximately 1/3. Therefore, during the radiologic evaluation of acute thalamic ischemia, a variant thalamic territory should be considered in the presence of infarction that does not fit the classic territory, in order to avoid clinical-radiological discrepancies.

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Section: Discussionsupporting

confidence: 89%

Topographic Evaluation of Acute Isolated Unilateral Thalamic Infarctions on Diffusion-weighted Imaging

Doğan¹

2020

jarem

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“…However, since treatment according to the guidelines is performed and the governmental medical insurance for the whole nation covers all people in Japan, a treatment bias is not very much likely. Embolism could lead a poor outcome without hyperlipidemia [ 22 , 23 ]. However, influence of embolism should be predominantly on CI.…”

Section: Discussionmentioning

confidence: 99%

Influences of hyperlipidemia history on stroke outcome; a retrospective cohort study based on the Kyoto Stroke Registry

Shigematsu

Watanabe

Nakano³

2015

BMC Neurol

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BackgroundAlthough hyperlipidemia is known as a risk factor of stroke, its effects on the outcome are unknown. The aim of the study is to clarify the influences of hyperlipidemia on the stroke early outcome by estimating odds ratio (OR) for sequelae requiring care and hazard ratio (HR) for death.MethodsA total of 12617 stroke patients registered in the Kyoto Stroke Registry with information on a hyperlipidemia history. We compared patients who had hyperlipidemia history and patients who hadn’t. The OR for remaining sequelae requiring certain care on 30 day after stroke was calculated using a logistic regression in stroke as a whole and in each stroke subtype; cerebral infarction (CI), cerebral hemorrhage (CH) and subarachnoid hemorrhage (SAH). The HR for death within 30 day after stroke was estimated by the Cox regression.ResultsThe OR (95% confidence interval) for remaining sequelae 30 days after stroke was 0.66 (0.60-0.73, p < 0.001) in patients with hyperlipidemia history compared with patients without hyperlipidemia history. After stratified by stroke subtypes, it was 0.75 (0.67-0.85, p < 0.001) in CI, 0.59 (0.45-0.77, p < 0.001) in CH and 0.77 (0.43-1.38, p = 0.767) in SAH. The HR (95% confidence interval) for death was 0.39 (0.31-0.48, p < 0.001) in patients with hyperlipidemia history comparing patients without hyperlipidemia history. After stratified by stroke subtypes, it was 0.45 (0.32-0.63, p < 0.001) in CI, 0.64 (0.44-0.93, p = 0.018) in CH and 0.76 (0.47-1.23, p = 0.264) in SAH. Each value was adjusted for age and sex.ConclusionsThis study suggests that the outcome is favorable for patients with hyperlipidemia history in terms of both remaining sequelae and HR for death. A factor which increases the incidence of the disease could influence on the severity of the disease in a favorable way.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0297-1) contains supplementary material, which is available to authorized users.

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“…Anterograde amnesia and short‐term memory impairment were also reported in central territory infarcts, and more severe than in anteromedian territory infarcts. However, because central territory infarcts can involve the adjacent nuclei of the classic territories, memory deficits of central territory infarcts are typically seen when involving the anterior portion of the central territory, overlapping with the anteromedian territory …”

Section: Variant Thalamic Territories and Associated Syndromesmentioning

confidence: 99%

“…However, because central territory infarcts can involve the adjacent nuclei of the classic territories, memory deficits of central territory infarcts are typically seen when involving the anterior portion of the central territory, overlapping with the anteromedian territory. 31…”

Section: Clinical Syndromementioning

confidence: 99%

Clinical and Neuroimaging Findings in Thalamic Territory Infarctions: A Review

Kumar

Gupta

et al. 2018

Journal of Neuroimaging

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The thalamus is a part of the diencephalon, containing numerous connections between the forebrain and subcortical structures. It serves an important function as a relay center between the cerebral cortex and the subcortical regions, particularly with sensory information. The thalamus also plays a major role in regulating arousal and the levels of awareness. Distinct vascular distribution of the thalamus give rises to different syndromic presentation of thalamic nuclei infarcts. The clinical records and available imaging studies of patients with confirmed thalamic territory infarcts on magnetic resonance imaging (MRI) at the University Hospital of Rochester were reviewed and analyzed. This analysis was then used to provide an effective summary of thalamic vascular anatomy, the clinical symptoms, and syndromes associated with strokes in the affected territories. Specifically, we review the syndromes associated with classic vascular territories, including the anterior, paramedian, inferolateral, and posterior thalamic nuclei, that are supplied by the polar (tuberothalamic), paramedian, inferolateral (thalamogeniculate), and posterior choroidal arteries, respectively. In addition, we will also review the variant thalamic territories and associated infarction syndromes of the anteromedian, central, and posterolateral territories. This review article is aimed to better the clinical and radiologic understanding as well as the diagnosis of classic and variant thalamic territory infarcts. This article will also briefly touch on the recovery of function after thalamic infarcts.

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Multiple variant type thalamic infarcts: pure and combined types

Abstract: We described multiple variant topographic patterns of thalamic infarction with distinct manifestations and etiologies. We thought that multiple variant infarcts are the result of variation in thalamic arterial supply or reflect a source of embolism.

Cited by 15 publications

References 47 publications

Topographic Evaluation of Acute Isolated Unilateral Thalamic Infarctions on Diffusion-weighted Imaging

Topographic Evaluation of Acute Isolated Unilateral Thalamic Infarctions on Diffusion-weighted Imaging

Influences of hyperlipidemia history on stroke outcome; a retrospective cohort study based on the Kyoto Stroke Registry

Clinical and Neuroimaging Findings in Thalamic Territory Infarctions: A Review

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