What Are the Symptoms of a Thalamic Stroke? - Oren Zarif - Thalamic Stroke

More thalamic strokes are being diagnosed each year, as the dominant hemispheric symptoms are easier to recognize and more common among patients. The asymmetric structure-function relationships of the thalamus are crucial to memory, language, and visuo-spatial neurocognitive functions. Fortunately, the diagnosis of a thalamic stroke can be easily made, with the aid of a mental screening test.

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Infarctions of the posterior cerebral arteries supply the thalamus and its lateral and posterior parts. The posterior cerebral artery and arteries of the P1 segment supply the thalamus. Anatomical variants of these arteries exist. The most common form is created by the separated trunks of both P1 segments. If one artery is occluding the other, it is called a posterior thalamoperforating artery.

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Typical neuropsychological deficits in a patient with a thalamic stroke can range from a fluctuating level of consciousness and personality changes to temporal disorientation and apprehension. Left-sided lesions are more common in patients with cognitive deficits, especially in verbal and visual memory. Right-sided lesions tend to cause less cognitive impairment and are associated with pain syndromes. If left thalamic lesions are involved in a patient's brain, they may cause acalculia, a condition associated with impaired arousal.

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Treatment for a thalamic stroke focuses on recovery as quickly as possible while minimizing the risk of another stroke. Recovery can involve physical therapy, speech and occupational health. Although the outlook for recovery after a thalamic stroke is individualized, it is a strong possibility for many patients. A person's level of recovery will depend on the severity of the symptoms they are experiencing and the type of stroke. The symptoms of a thalamic stroke can last for weeks or months and may include residual effects.

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The thalamus is an important part of the brain, relaying sensory and motor information to the cortex. Damage to the thalamus' anterior nucleus can result in neuropsychological disturbances. Early involvement may result in reduced level of consciousness, which can last hours or even days. At the same time, patients may experience agitation, aggression, or decreased responsiveness. If this pattern is present, a patient should be evaluated immediately to determine if there is a thalamic stroke.

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Another study published in 2010 described the behavioral consequences of a thalamic hemorrhage in patients with a diagnosis of ischemic stroke. In a study of 102 thalamic patients, Fisher described sensory deficits associated with neglect, global dysphasia, and visual hallucinations. The study confirmed a relation between thalamic lesions and the associated cognitive deficits. However, a thalamic infarct may not be an isolated occurrence and should be considered in a patient's differential diagnosis of an intracranial artery occlusion.

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More work needs to be done to determine the role of the thalamus in memory. MRI imaging of the thalamus is difficult and requires highly accurate images of the nuclei and tracts. Dedicated structural MRI sequences are under development. In the near future, 7 Tesla imaging may become available for clinical diagnosis. Furthermore, specific lesions caused by MD in nonhuman primates may be different from those in humans.

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Lesions to the thalamus may cause sensory loss or ataxic hemiparesis. Lesions to the inferolateral artery can cause thalamic hand. This is the first sign of thalamic stroke. However, other signs of the disease may be absent or infrequent. In addition to sensory loss, lesions of the inferolateral artery are common in thalamic stroke.

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A subgroup of thalamic stroke patients may be missed in the prehospital setting. These patients may have less recognizable symptoms, and thus may not receive timely treatment and secondary prophylaxis. More research is needed to better understand the clinical characteristics of this subgroup of patients and identify diagnostic instruments that can be used to make a diagnosis. The goal of this study was to identify patients with this diagnosis, and to determine if their stroke symptoms are related to the location of their brain in the thalamus.