Bithalamic lesions

Bilateral thalamic lesions usually seen in combination with basal ganglia and /or white matter and sometimes cortical lesions. Symmetrical bilateral involvement of the thalami has relatively limited differential diagnosis, including metabolic, vascular, toxic, ischaemic, infectious, or hypoxic causes:

• vascular
  • deep vein occlusion: internal cerebral veins, vein of Galen, or straight sinus
  • arterial ischemia
    • ​artery of Percheron occlusion
    • top of the basilar artery syndrome
  • ​vasculitis 
• hypoxic-ischemic encephalopathy
  • infection/inflammation
  • acute disseminated encephalomyelitis
• Creutzfeldt-Jakob disease
• viral encephalitis
• toxic/metabolic
  • osmotic extrapontine demyelination
  • Wernicke encephalopathy
• status epilepticus
• ilicit drugs
• inherited disorders
  • mitochondrial disorders
  • Wilson disease
  • Fabry disease
  • Fahr disease
• neoplasms
  • low grade astrocytoma
  • glioblastoma cerebri