Sensory ataxic hemiparesis in thalamic hemorrhage.

Abstract

Ataxic hemiparesis with cerebellar-like features has been reported following infarction or hemorrhage of the thalamus. We describe five patients with incoordination and corticospinal tract signs in the limbs opposite a dorsolateral thalamic hemorrhage. In four patients the hemorrhage extended superiorly into the lateral ventricle, the adjacent paraventncular region, and the upper and medial parts of the posterior limb of the internal capsule. Instead of cerebellar dysfunction, these patients exhibited directional errors of movement that improved distinctly when performed under visual guidance. We explain the incoordination on the basis of conscious deep sensory loss in the involved limbs. Perception of light touch, painful pinprick, and temperature were preserved in all patients. We use the term "sensory ataxic hemiparesis" to distinguish these patients from those with "classic" ataxic hemiparesis and cerebellar-like features, a distinction that may be important when planning functional rehabilitation. (Stroke 1990;21:1749-1753)

Post-Thalamic Stroke Movement Disorders: A Systematic Review

“…Hyperesthetic ataxic hemiparesis was described in 8 cases, hyperesthetic hemiataxia was described in 24 cases, ataxic hemiparesis was described in 11 cases and sensory hemiataxia was described in 5 cases [14, 42, 46, 47, 50, 51, 54, 55, 58, 88, 102]. Isolated hemiataxia was described in 3 cases.…”

“…This is in contrast to the studies of Alarcon et al [3] and D’Olhaberriague et al [15], where chorea and hemichorea-hemiballismus were reported as the most common acute movement disorders respectively. Hemiataxia was described as ataxic hemiparesis, hypesthetic hemiataxia, hypesthetic ataxic hemiparesis or sensory hemiataxia [14, 41, 42, 46, 47, 50, 51, 54, 55, 58, 63]. Dobato et al [14] reported 5 patients with sensory ataxic hemiparesis following thalamic haemorrhage, where all patients had loss of deep sensations like joint and position sense.…”

Ataxic Hemiparesis

“…There are frequently reported patients with subjective numbness, usually without sensory loss, and 1 patient 13 had accompanying pain without sensory loss. Review of the published cases reveal that also noted but not emphasized by the authors were 2 cases of contralateral Horner's syndrome, 14 ipsilateral facial hypesthesia, [15][16][17][18][19] and ipsilateral tongue deviation 8,19 -23 (presumably considered part of the hemiparesis). A more recent report of 2 patients, 17 1 with fleeting symptoms of weakness and corticospinal tract signs and the other with mild weakness, both accompanied by ataxia and prominent hemisensory loss was coined "hypesthetic-ataxic-hemiparesis" and likened to the DejerineRoussy (thalamic) syndrome.…”

“…Landau 25 asserts that some degree of clumsiness will be found in virtually any patient with hemiparesis and that it is nearly impossible to differentiate the 2 types of clumsiness clinically. Impaired position sense was thought to be the mechanism behind the ataxic component of the syndrome 14,26 in 5 patients 14 and was dubbed "sensory ataxic hemiparesis" (all of whom had thalamic lesions). Other reports 27 argue for cerebellar-type findings in patients with cortical infarction and postulate that the mechanism is intrinsic to the role of the lateral cerebellar hemisphere in integrating and communicating information from the cortical sensory association areas (superior parietal lobule) to the motor and premotor cortexes.…”

“…In 1 case 46 infarction related to cysticercosis-induced meningovasculitis was found. In abundant case reports other etiologic mechanisms, such as hemorrhage, 12,14,16,17,20,28,39,[47][48][49] trauma, 50 and neoplastic infiltration 23,28,51,52 have been well documented. Information from studies in which neuroimaging was used to diagnose small, deep infarcts provides some evidence for diffuse etiologic mechanisms, with 33% of those patients with small deep infarcts on CT scan having either a potential cardiac or carotid embolic source.…”