Thalamic infarct

Last revised by Tom Foster on 28 May 2020

Thalamic infarcts refer to ischemic strokes which affect the subcortical grey matter complex of nuclei known as the thalamus.

Pure thalamic infarcts are reported to make up 3-4% of cerebral ischemic events 1

Most of the risk factors are common to all types of ischemic infarcts 2 and include:

Presentation is dependent on the region infarcted 2,5:

The main cause of infarction is thrombotic occlusion secondary to atherosclerosis, the most common sites being the carotid bifurcation, the origin of the middle cerebral artery and the basilar tip 3

Classic thalamic territories include 5:

Non-contrast CT may show ill-defined hypodensities of the thalamus or obscuration of the grey-white matter border between the adjacent internal capsule 4.

In the acute phase (within 72 hours) 4:

  • T2/FLAIR: normal to slightly hyperintense grey-matter (as infarct progresses)
  • DWI: hyperintense
  • ADC: hypointense

Thalamic strokes are typically medically managed and have a wide variety of prognoses depending on the location, size and nature of the infarct.

Cases have reported good outcomes regarding return to normal neurological function. The exception is with bilateral paramedian territory infarctions where cognitive deficits tend to persist in follow-up 1.

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Cases and figures

  • Case 1: bilateral
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5
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  • Case 6
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