Post-Thalamic Stroke Movement Disorders: A Systematic Review

Abstract

Background: After a stroke, movement disorders are rare manifestations mainly affecting the deep structures of the brain like the basal ganglia (44%) and thalamus (37%), although there have been case studies of movement disorders in strokes affecting the cerebral cortex also. Summary: This review aims to delineate the various movement disorders seen in association with thalamic strokes and tries to identify the location of the nuclei affected in each of the described movement disorders. Cases were identified through a search of PubMed database using different search terms related to post-thalamic stroke movement disorders and a secondary search of references of identified articles. We reviewed 2,520 research articles and only 86 papers met the inclusion criteria. Cases were included if they met criteria for post-thalamic stroke movement disorders. Case-cohort studies were also reviewed and will be discussed further. Key Messages: The most common post-stroke abnormal movement disorder reported in our review was dystonia followed by hemiataxia. There was a higher association between ischaemic stroke and movement disorder. Acute onset movement disorders were more common than delayed. The posterolateral thalamus was most commonly involved in post-thalamic stroke movement disorders.

Clinical and Demographic Characteristics of Upper Limb Dystonia

“…The Dystonia Coalition does not require neuroimaging of the neural axis to exclude potentially overlooked secondary structural lesions that may contribute to a small percentage of those categorized as isolated dystonia for study entry. 35,36 Furthermore, all examinations were performed at least 2 months after botulinum toxin injection, but lingering effects could still alter dystonia manifestations. 37 Nevertheless, these data on ULD focality, task specificity, and likelihood of regional spread may inform clinical counseling and future efforts in the design, execution, and interpretation of clinical trials.…”

“…In addition, those with mild disease that are either underrecognized or not seeking treatment are less likely to attend one of our recruiting sites. The Dystonia Coalition does not require neuroimaging of the neural axis to exclude potentially overlooked secondary structural lesions that may contribute to a small percentage of those categorized as isolated dystonia for study entry 35,36 . Furthermore, all examinations were performed at least 2 months after botulinum toxin injection, but lingering effects could still alter dystonia manifestations 37 .…”

Posterior Variant of Alien Limb Syndrome with Sudden Clinical Onset as Self-Hitting Associated with Thalamic Stroke

“…Partial or complete occlusions of the posterior cerebral artery generally result in infarctions that extend beyond the thalamic territory [16]. However, cases of isolated thalamic infarcts can be found in small vessel disease, sometimes associated with movement disorders [17]. Thus, our case suggests that the thalamus can act as a highly localized trigger for the syndrome.…”

A Case of Myoclonic Epilepsy Presenting with Status Epilepticus in an Elderly Male Patient

“…However, another possible origin of this clinic may be the ischemic lesions of the thalamus which also have been hypothesized to be the responsible sites from the myoclonic movements in recent studies. 16,17 Overall, these views can only be hypothetic in the absence of further advanced investigation results (investigations of motor and somatosensory evoked potentials, functional neuroimaging, etc. ).…”