Bilateral thalamic infarcts

Case contributed by Dr Julian Maingard

Presentation

90 yo female presents with unconscious collapse. GCS 6

Patient Data

Age: 90
Gender: Female
Modality: CT

Bilateral thalamic hypodensities suggestive of bilateral infarction. 

Case Discussion

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. 

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Case Information

rID: 31515
Case created: 14th Oct 2014
Last edited: 18th Dec 2015
Inclusion in quiz mode: Included

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