Bithalamic lesions

Changed by Soheil Niku, 17 Jul 2023

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Disclosures - updated 13 Jul 2023: Nothing to disclose

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Overview

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-ischaemic encephalopathy
infectious
- Creutzfeldt-Jakob disease
- viral encephalitis (eg, neurotropic flaviviruses)
- malaria
autoimmune
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

Mnemonic

SEED is a mnemonic created by Soheil Niku, M.D., a radiologist practicing in San Diego, CA, to remember the main causes of bilateral thalamic lesions. Think of the thalami as two seeds in the middle of the brain.

Stroke (artery of Percheron & venous infarcts)

Encephalitis (flavivirus & vCJD)

Encephalopathy (Wernicke encephalopathy & PRES)

Demyelination (osmotic demyelination & ADEM)

Two categories not included in the above mnemonic but worth remembering are congenital disorders (Leigh syndrome) and neoplastic disorders (bilateral thalamic gliomas).

-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:<ul>
+<h4>Overview</h4>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:<ul>
~~-</ul>~~
+</ul><h4>Mnemonic</h4>SEED is a mnemonic created by Soheil Niku, M.D., a radiologist practicing in San Diego, CA, to remember the main causes of bilateral thalamic lesions. Think of the thalami as two seeds in the middle of the brain.Stroke (artery of Percheron & venous infarcts)Encephalitis (flavivirus & vCJD)Encephalopathy (Wernicke encephalopathy & PRES)Demyelination (osmotic demyelination & ADEM)Two categories not included in the above mnemonic but worth remembering are congenital disorders (Leigh syndrome) and neoplastic disorders (bilateral thalamic gliomas).

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Bithalamic lesions

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Overview

Mnemonic

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