Bithalamic lesions

Last revised by Liz Silverstone ◉ ◈ on 4 Feb 2025

Citation, DOI, disclosures and article data

Citation:

Rezaee A, Silverstone L, Walizai T, et al. Bithalamic lesions. Reference article, Radiopaedia.org (Accessed on 22 Mar 2025) https://doi.org/10.53347/rID-36603

DOI:

https://doi.org/10.53347/rID-36603

Permalink:

https://radiopaedia.org/articles/36603?embed_domain=external.radpair.com%25252527%2525255b0%2525255d%25252527%2525255b0%2525255d

rID:

36603

Article created:

1 May 2015, Amir Rezaee

Disclosures:

At the time the article was created Amir Rezaee had no recorded disclosures.

View Amir Rezaee's current disclosures

Last revised:

4 Feb 2025, Liz Silverstone ◉ ◈

Disclosures:

At the time the article was last revised Liz Silverstone had no financial relationships to ineligible companies to disclose.

View Liz Silverstone's current disclosures

Revisions:

17 times, by 12 contributors - see full revision history and disclosures

Systems:

Central Nervous System

Tags:

re-write

Synonyms:

Bilateral thalamic lesions
Bithalamic lesions

Bilateral thalamic lesions are usually seen in combination with basal ganglia, white matter and sometimes cortical lesions.

The assessment and differential approach can utilise radiological markers such as MR signal characteristics, calcifications, precise position within the thalamus, symmetry/asymmetry, the presence of concurrent extra-thalamic lesions, and the existence of expansion ⁶. It is essential to consistently seek a correlation between clinical and laboratory findings while further follow-up imaging often provides helpful insights, particularly when the baseline imaging method is equivocal ⁶.

Bilateral involvement of the thalami has a broad differential diagnosis:

vascular
- deep cerebral vein thrombosis and dural venous sinus thrombosis ¹⁰
- arterial infarcts
  - artery of Percheron occlusion ⁷
  - top of the basilar artery syndrome ⁸
- posterior reversible encephalopathy syndrome
- hypoxic-ischaemic encephalopathy
infectious
- Creutzfeldt-Jakob disease ⁹
- viral encephalitis (e.g. 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

References

1. Menon G, Nair S, Sudhir J et-al. Bilateral thalamic lesions. Br J Neurosurg. 2010;24 (5): 566-71. doi:10.3109/02688691003777915 - Pubmed citation
2. Linn J, Hoffmann LA, Danek A et-al. Differential diagnosis of bilateral thalamic lesions. Rofo. 2007;179 (3): 234-45. doi:10.1055/s-2007-962857 - Pubmed citation
3. Khanna PC, Iyer RS, Chaturvedi A et-al. Imaging bithalamic pathology in the pediatric brain: demystifying a diagnostic conundrum. AJR Am J Roentgenol. 2011;197 (6): 1449-59. doi:10.2214/AJR.11.6702 - Pubmed citation
4. Osborn AG. Osborn's Brain. Lippincott Williams & Wilkins. ISBN:1931884218. Read it at Google Books - Find it at Amazon
5. Smith AB, Smirniotopoulos JG, Rushing EJ, Goldstein SJ. Bilateral thalamic lesions. (2009) AJR. American journal of roentgenology. 192 (2): W53-62. doi:10.2214/AJR.08.1585 - Pubmed
6. Arkoudis NA, Filippiadis DK, Toulas P, Velonakis G. Bilateral Thalamic Lesions: A Pictorial Essay. Hellenic Journal οf Radiology. 6(3). doi:10.36162/hjr.v6i3.434
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8. Ahn S, Kim B, Kim Y, Kang D, Kwon S, Kim J. Patterns and Outcomes of the Top of the Basilar Artery Syndrome: The Role of the Posterior Communicating Artery. Cerebrovasc Dis. 2018;46(3-4):106-15. doi:10.1159/000492059 - Pubmed
9. Fragoso D, Gonçalves Filho A, Pacheco F et al. Imaging of Creutzfeldt-Jakob Disease: Imaging Patterns and Their Differential Diagnosis. Radiographics. 2017;37(1):234-57. doi:10.1148/rg.2017160075 - Pubmed
10. Poon C, Chang J, Swarnkar A, Johnson M, Wasenko J. Radiologic Diagnosis of Cerebral Venous Thrombosis: Pictorial Review. AJR Am J Roentgenol. 2007;189(6 Suppl):S64-75. doi:10.2214/AJR.07.7015 - Pubmed