Bithalamic lesions

Bilateral thalamic lesions are usually seen in combination with basal ganglia, white matter and sometimes cortical lesions. Symmetrical bilateral involvement of the thalami has a broad differential diagnosis:

• vascular
  • deep cerebral vein thrombosis and dural venous sinus thrombosis:
    • internal cerebral veins
    • vein of Galen
    • straight sinus
  • arterial infarcts
    • ​artery of Percheron occlusion
    • top of the basilar artery syndrome
  • posterior reversible encephalopathy syndrome
  • hypoxic-ischemic encephalopathy
• infectious
  • Creutzfeldt-Jakob disease
  • viral encephalitis
• autoimmune
  • acute disseminated encephalomyelitis
• metabolic/toxic
  • osmotic extrapontine demyelination
  • Wernicke encephalopathy
• neoplasms
  • low grade astrocytoma (bilateral thalamic glioma)
• congenital disorders
  • mitochondrial disorders such as Leigh syndrome
  • Wilson disease
  • Fabry disease
  • Fahr disease
• status epilepticus