Bilateral thalamic infarcts
Patient found unconscious. GCS 6
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Bilateral thalamic hypodensities suggestive of bilateral infarction.
Thalamic infarcts are generally asymmetric and due to multiple emboli or small vessel ischaemia. Bilateral thalamic infarction is uncommon 1. Prognosis is thought to be poor especially if associated with midbrain infarction 2. This relates to a persistence of cognitive and psychiatric manifestations rather than mortality and recovery from motor deficit 3. Causes include:
- artery of percheron occlusion 1
- cerebral venous thrombosis 4
- top of the basilar syndrome
The blood supply of the thalamus is predominantly from the posterior cerebral artery. There are 4 major vascular territories of the thalamus supplied by the tuberothalamic, inferolateral, paramedian, and posterior choroidal vessels 5. There is wide variability among individuals. Vascular anatomical variations are documented and include the "artery of Percheron". This uncommon anatomical variant describes a single dominant thalamomesencephalic artery supplying the bilateral medial thalami6.
Venous drainage of the thalamus is via the thalamo-striate veins draining into the internal cerebral vein and perforating veins draining into basal veins. Both eventually drain into the great cerebral vein prior to drainage into the venous sinuses 7.
It was unclear whether an artery of Percheron was present in this individual as they did not proceed to MRA to further characterise the cerebral vasculature.
- 1. Matheus MG, Castillo M. Imaging of acute bilateral paramedian thalamic and mesencephalic infarcts. AJNR Am J Neuroradiol. 2004;24 (10): 2005-8. Pubmed citation
- 2. Arauz A, Patiño-Rodríguez HM, Vargas-González JC et-al. Clinical Spectrum of Artery of Percheron Infarct: Clinical-Radiological Correlations. J Stroke Cerebrovasc Dis. 2013; . doi:10.1016/j.jstrokecerebrovasdis.2013.09.011 - Pubmed citation
- 3. Jiménez Caballero PE. Bilateral paramedian thalamic artery infarcts: report of 10 cases. J Stroke Cerebrovasc Dis. 2010;19 (4): 283-9. doi:10.1016/j.jstrokecerebrovasdis.2009.07.003 - Pubmed citation
- 4. Gossner J, Larsen J, Knauth M. Bilateral thalamic infarction-a rare manifestation of dural venous sinus thrombosis. Clin Imaging. 2010;34 (2): 134-7. doi:10.1016/j.clinimag.2009.05.008 - Pubmed citation
- 5. Schmahmann JD. Vascular syndromes of the thalamus. Stroke. 2003;34 (9): 2264-78. doi:10.1161/01.STR.0000087786.38997.9E - Pubmed citation
- 6. Lazzaro NA, Wright B, Castillo M et-al. Artery of percheron infarction: imaging patterns and clinical spectrum. AJNR Am J Neuroradiol. 2010;31 (7): 1283-9. doi:10.3174/ajnr.A2044 - Pubmed citation
- 7. McMINN. Lasts Anatomy Regional and Applied. CHURCHILL LIVINGSTONE. (2003) ISBN:B0084AQDG8. Read it at Google Books - Find it at Amazon