Vertical gaze palsy is a common manifestation of thalamic eye disease, but other symptoms and signs may be present (see Table 1). However, more often, diagnosis is only clinical; actually, patients with bilateral paramedian thalamic lesions may develop altered sensorium, vertical gaze palsy, and memory impairment. Bilateral thalamic glioma is a rare neoplasm, usually a diffuse low-grade astrocytoma (World Health Organization grade II), that occurs in both children and adults [ 1 ]. Signs and Symptoms Bilateral thalamic lesions commonly produce more severe ocular motility deficits when compared to unilateral lesions. Bilateral thalamic infarction (BTI) is a rare entity that represents 0.6% of the first cerebrovascular ischaemic event. Thus, treatment of high blood pressure, even in mild hypertension, needs to be encouraged. A 52 year old man complained of diplopia, dizziness, vertigo, decrease of consciousness, memory impairment, and hyperphagia. Anti-AQP4 antibody was detected in his serum. Introduction. to upper respiratory tract, pneumonia, or gastrointes- tinal symptoms. : Bilateral Reversible Thalamic Lesions on CT Fig. Thalamic Blood Supply and Vascular Syndromes. Seizure. Bilateral thalamic lesions are rare and relatively obscure neoplasms. However, some general symptoms of a thalamic stroke include: loss of sensation difficulties with movement or. Mullan S, Vailati G, Karasick J, Mailis M. Thalamic lesions for the control of epilepsy: Astudy of nine cases. DAVFs present mostly in adulthood and are located in the transverse, sigmoid, and Bilateral sensory loss predicted accurately bilateral infarction in the territory of thalamogeniculate arteries. Symmetrical bilateral involvement of the thalami has a broad differential diagnosis: vascular. The artery of Percheron is a rare anatomic variant of arterial supply to the paramedian thalamus and rostral midbrain, and occlusion of the artery of Percheron results in bilateral paramedian thalamic infarcts with or without midbrain involvement. Conversely, lesions involving the medio-dorsal (MD), midline or intralaminar nuclei have been associated with the occurrence of executive dysfunctions [3] [5] [6]. Everyone is different and symptoms will vary in individual cases. Sensory symptoms that may appear as harmless may easily be ignored, but acute sensory symptoms defined with a remarkable midline split, especially when both head and trunk are involved, is often considered unique to thalamic or thalamocortical lesions , and augur a minor stroke. Bilateral thalamic lesions: a pictorial essay, p. 40-49 gram, and detection of 14-3-3 protein in the CSF are required. It can be classified into mild, moder- ate, and severe infections. 1. . Bilateral thalamic primary gliomas are an exceedingly rare entity, with fewer than 75 cases reported in the literature to date .Bilateral thalamic gliomas represent a small subset of primary thalamic gliomas, accounting for an estimated 1-1.5% of all brain tumors .Symptomology heralding a workup and diagnosis of bithalamic gliomas is diverse and varies between the pediatric and adult populations. Thalamic lesions can cause chronic pain, sensory loss, amnesia, dystonia and other disorders [1]. C and D second CI" examination 2 months later. The symptoms consisted of dysexecutive disturbances associated with confabulating behavior and auto-activation deficits. Surgical intervention is limite … [CNS] lymphoma, primary bilateral thalamic glioma [PBTG]) may also affect the basal ganglia and thalamus on both sides. 928 Volume 84, No. 6 ANNALS of Neurology Bilateral thalamic infarcts due to occlusion of the Artery of Percheron and discussion of the differential diagnosis of bilateral thalamic lesions. However, of thalamic strokes, occlusion of artery of Percheron is . Bilateral thalamic primary gliomas are an exceedingly rare entity, with fewer than 75 cases reported in the literature to date [1]. Changes in consciousness, hypersomnia, mood disorders, cognitive problems and paralysis of vertical gaze may be observed in patients with acute bilateral paramedian thalamic infarct. These lesions may be complicated by cytotoxic edema (lowering or pseudonormalizing ADC values) and/or hemorrhage. The details of thalamic vascularization were first studied by Duret 9 and Foix and Hillemand 10 and subsequently by Lazorthes 11 and Plets et al. Objective: Clinical, neuropsychological, structural and functional neuroimaging results are reported in a patient who developed a unique combination of symptoms after a bi-thalamic and right putaminal stroke. Symptoms of brain lesions vary depending on the type of lesion, its extent, and where it is found. A stroke in the thalamus can have unique effects for every survivor. Thalamic dementia: arteriovenous fistula Gonçalves et al. What are the symptoms of brain lesions? The improvement in MR appearance and clinical symptoms in both cases would suggest that the thalamic lesions reflect venous hyperten-sion as opposed to infarction. CT and MR imaging revealed a unilateral thalamostriate lesion. Conversely, R.F. Bilateral thalamic lesions are rare. The anatomical distribution of her problem—cheiro-oral syndrome with concurrent hypogeusia—suggested . Bilateral thalamic infarction is a rare presentation of posterior circulation stroke. Almost all of these lesions on histology prove to be gliomas but decompressive surgery is seldom feasible. Rare causes Fabry disease is an X-linked disorder of glycosphingolipid metabolism leading to Persistent dementia and Venous thrombosis of the deep venous system, the vein of Galen, or the straight sinus can lead to bilateral thalamic vasogenic edema (hyperintense on both DWI and ADC map) (Figure 7 ). Conclusion: The limited differential diagnosis of bilateral thalamic lesions can be further narrowed with knowledge of the specific imaging characteristics of the lesions in combination with the . [1, 2] Patients present with a variable clinical presentation that includes fluctuations in the state of consciousness, a "sleep-like coma " stage, confusion and disorientation. Abstract: The Percheron artery (artery of Percheron, AOP) is a rare variant vessel. The unusual aspects of the radiological findings were that the lesions were bilateral and localized symmetrically in the thalami. However, presence of headache is somewhat odd. Her problem remains sufficiently severe to cause distress and nutritional deficit. Bilateral thalamic glioma has a poor prognosis due to the location of the lesions. differential diagnosis of bilateral thalamic disease. Symptomology heralding a workup and diagnosis CNS vasculitis may present Bilateral thalamic lesions are uncommon, and those caused by DAVFs are even rarer. Cognitive improvement after long-term electrical stimulation of bilateral anterior thalamic nucleus in refractory epilepsy patients. Thalamic stroke symptoms vary depending on the part of the thalamus that's affected. Primary bilateral thalamic lesions have characteristic neuroradiological properties and are distinct from unilateral thalamic tumours with bilateral progression. Partial regression of both thalamic lesions. identical to symptoms caused by direct cerebellar damage. Bilateral acute synchronous arterial infarctions of the thalamus are not uncommon, and are usually the result of occlusion of the rostral basilar artery. On MRI basal ganglia, thalami and cerebral During the acute phase, brain MRI showed in both children bilateral hyperintense areas on T2-weighted sequences limited to both thalamic regions. All patients except one presented with raised intracranial pressure symptoms. We herein reported a case of HE with unusual thalamic lesions on MRI. Here, we report a case of probable ADEM with symmetrical bilateral thalamic lesions. Children typically have signs of increased intracranial pressure and movement disorders. The first one is characterised by hemisensory loss, hemiataxia, and involuntary movements. However, more often, diagnosis is only clinical; actually, patients with bilateral paramedian thalamic lesions may develop altered sensorium, vertical gaze palsy, and memory impairment. We present our experience with nine cases of bilateral thalamic lesions and attempt to analyse them in the background of available literature. The only risk factor of ischaemic stroke found . A 67-year-old male patient with bilateral thalamic stroke was studied with positron emission tomography, magnetic resonance imaging, and cognitive assessment, performed at baseline and at two . Bilateral thalamic vasogenic edema seen as hyperintensity on both axial FLAIR (a) and coronal . As this case presented, memory deficits and confusion are the main symptoms, which are due to the retrograde flow of the fistula into the straight sinus and Galen vein, which resulted in thalamic edema and functional deficits. A thalamic glioma, as its name implies, is a glial tumor characterized by a primary growth center within or very near the thalamus. Moreover, this 70-year-old man tolerated bilateral freezing thalamic lesions within a 2-week period without any untoward effect. He was discharged from the hospital 9 days after the 2nd thalamic . Brain histologic analyses revealed lymphocytic infiltration only into the thalamus, without infection . ; Krishnakumar, K. British Journal of Neurosurgery 24(5): 566-571 2010 ISSN/ISBN: 0268-8697 . These lesions may be complicated by cytotoxic edema (lowering or pseudonormalizing ADC values) and/or hemorrhage. The second and third ones include pure sensory and sensory-motor deficits, respectively [ 4 ]. Lesions were attributed to Posterior Reversible Encephalopathy Syndrome. Multiple lesions, related to the presence of a greater number of risk factors (especially . Symptoms are related to lesion location and the pattern of venous drainage . Lesions are rarely observed in. Oh YS, Kim HJ, Lee KJ, Kim YI, Lim SC, Shon YM. There are 4 major thalamic vascular territories, each with a . as marked improvement in the patient's symptoms after surgery. Theterminologycanbeconfusingbecauseofthevariety of names and definitions, complex interconnections and interactions. Summary: Thrombosis of the deep venous system presenting with bilateral thalamic infarction or edema is a common finding, but unilateral venous thrombosis presenting with unilateral thalamic edema is extremely rare. Use the links below to … Understanding Thalamic Stroke: Effects, Treatment, and Recovery Read More » 2A-F. Case 2. Its acute occlusion can cause a bilateral symmetrical thalamic stroke; typical symptoms of bilateral paramedian thalamic infarcts due to occlusion of AOP are vertical gaze palsy, memory impairment, confusion, drowsiness . Although the bilateral thalamic lesions shrank after steroid pulse, IV immunoglobulin, and long-term oral steroid, the patient died of aspiration pneumonia 7 months after encephalitis onset. We describe a patient who presented with a left Bilateral thalamic lesions are in general uncommon . The patient was transferred to DAVF-induced bithalamic lesions were almost exclusively observed in men, and were most common in the fifth to seventh . We present an atypical case of bilateral paramedian thalamic infarct with concomitant hypothalamic dysfunction. Marked improvement in these lesions following repeated steroid pulse therapy indicated that the lesions were caused by an immune process, which 12 Cases may present with neurological symptoms related to either the peripheral nervous system or central nervous system. Although it may have many causes, the most common is atherosclerotic small vessel disease. Venous thrombosis of the deep venous system, the vein of Galen, or the straight sinus can lead to bilateral thalamic vasogenic edema (hyperintense on both DWI and ADC map) (Figure 7). shows a more asymmetrical involvement of the thalamus, with the right lesion considerably larger than the left one (A). Bilateral thalamic glioma has a poor progno- sis due to the location of the lesions [2]. MR spectroscopy can help to differentiate bilateral thalamic gliomas from other lesions [2, 4]. A and B first CT examination in acute phase. FIGURE 2: Lesions in patients presenting with coma (A,B) or stupor (C,D). These cases are presented to emphasize that such H. Marcu et al. DAVFs are vascular malformations in which meningeal arteries drain directly into dural venous sinuses, meningeal veins, or subarachnoid veins. presents with a more symmetrical thalamic involvement, with both lesions showing a similar location and extension (B). Case presentation Severe infection occurs less frequently and includes respiratory distress, decreased oxygen saturation, cyanosis, feeding difficulties, loss of consciousness, seizures, or shock. Loss of sense of taste (hypogeusia) involving a part of the tongue can follow acute stroke. In each, bilateral thalamic infarcts extended into the posterior hypothalamus and midbrain (A-D) and in 2, the pons (A,B). The thalamus is supplied primarily by the posterior cerebral artery (PCA). BehaviouralNeurology (a) (b) (c) (d) (e) (f) (g) (h) (i) F : alamic infarctions in the thalamogeniculate artery territory (arrows in a, d, and g) in di erent patients (patient in a, b, and . Both focal and systemic disorders may manifest as bithalamic abnormalities, including neoplastic, infectious, vascular, toxic, metabolic, and demyelinating disorders and disorders of congenital origin [ 1 ]. thalamic nuclei or the mammillo-thalamic tract (MTT) [2] [3] [4]. The incidence is estimated at 0.6% of all first-ever ischemic strokes and 22-35% of all thalamic infarcts [1], [2], [3]. Of these, dural arteriovenous fistulas (DAVFs) are a rarely reported cause. The differential diagnosis can be further narrowed down with the patient history, imaging characteristics, and the presence or absence of . 12 The subject was reevaluated by Percheron, 13-17 and subsequent reports helped to simplify the clinical-anatomic considerations. eral thalamic lesions, the following possibilities were kept as differentials. There are 4 major thalamic vascular territories, each with a . 21 . vein of Galen. Ataxia arising from thalamic injury can occur on the side of the body contralateral to the lesion.1-6 However, little is known about ipsilateral or bilateral ataxia induced by unilateral thalamic lesions. The intervening white matter between the abnormal right cortical and thalamic lesions was normal in serial follow-up MRI imaging. The thalamus, a paired structure that is positioned just above the brainstem, is a major processing and . Bilateral thalamic lesions are usually seen in combination with basal ganglia, white matter and sometimes cortical lesions. All patients except one presented with raised intracranial pressure symptoms. 18-27. Bilateral thalamic damage detectable on T1-weighted images of the two patients. Rodriguez EG , Lee JA J Radiol Case Rep , 7(7):7-14, 01 Jul 2013 Patients with thalamic infarction typically present with agitation, obtundation or coma, memory dysfunctions, and various types of ocular and behavioral changes. There is a symmetrical, hypodense area in each thalamic region (arrowheads). We reviewed the cases reported in PubMed (summarized in Table 2). Severe infection occurs less frequently and includes respiratory distress, decreased oxygen saturation, cyanosis, feeding difficulties, loss Received: 18 December 2021 | Initial evaluation revealed bilateral thalamic lesions and a mild neutrophilic-predominant pleocytosis on cerebrospinal fluid analysis, the latter of which has not been described in previously published cases. We report a case of a patient with this unusual condition presenting with nonspecific clinical signs and symptoms. Bilateral thalamic glioma This is a rare neoplasm and is usually a diffuse low-grade astrocytoma (WHO grade II), occurs in both children and adults. Adults experience mental deterioration [1]. bilateral hypothalamic and anterior thalamic lesions. We describe a woman with a small right thalamic acute infarct causing bilateral (mainly left-sided) hypogeusia. Background: Basal ganglia and thalamic lesions may result in a . Materials and methods. The straight sinus DAVF was the most likely symptomatic fistula. The details of thalamic vascularization were first studied by Duret 9 and Foix and Hillemand 10 and subsequently by Lazorthes 11 and Plets et al. Acute artery of Percheron infarcts represent 0.1 to 2% of total ischemic stroke. Figure Reversible Thalamic Lesions With Atezolizumab-Induced Encephalitis Before and After Immunotherapy. Bilateral thalamic lesions Menon, G.; Nair, S.; Sudhir, J.; Rao, B.R.M. Seven of these patients had radiological evidence of bilateral thalamic lesions at presentation and 2 patients had involvement of the opposite thalamus at a later stage of the disease. Although magnetic resonance (MR) imaging is the modality of choice for evaluating the basal ganglia, computed tomography (CT) may be the first line of investigation, particularly in emer- Arterial stroke—Artery of Percheron infarct, CNS vasculitis. 1967. 2012. The lesions of these paired structures have a limited differential diagnosis that includes metabolic and toxic processes, infections, vascular lesions, and neoplasia. (B) Follow up imaging obtained 20 days later displays subsidence of imaging findings in the aforementioned regions. (Vascular lesion like artery of Percheron infarction may lead to bilateral thalamic hyperintensities. Brain lesions are typically a symptom of this disease. Bilateral thalamic primary gliomas are an exceedingly rare entity, with fewer than 75 cases reported in the literature to date [1]. In that case the strategy of embolization is to catheterize and embolize the origin of the fistula until it is obliterated20, as we have done. onset of clinical symptoms. Artery of Percheron territory infarct is rare, on account of the relative rarity of the artery of Percheron, and presents with a variety of signs and symptoms collectively termed the paramedian thalamic syndrome.It is a type of posterior circulation infarction.. On imaging, it is classically characterized by bilateral infarcts in areas involving the rostral midbrain and/or ventromedial thalamus. These disorders include, above all, vascular disorders, which must be differentiated into. An autopsy revealed no evidence of cancer recurrence. Tumors are also a cause of brain lesions and abnormal growth of brain cells. There are three different clinical syndromes associated with lesions affecting the lateral thalamus. Bilateral thalamic venous edema with subsequent hemorrhagic transformation resulted from DAVF draining retrogradely into the proximal straight sinus, vein of Galen, and internal cerebral veins. Presence of these atypical features prompted extensive diagnostic evaluation. Seven of these patients had radiological evidence of bilateral thalamic lesions at presentation and 2 patients had involvement of the opposite thalamus at a later stage of the disease. Symptomology heralding a workup and diagnosis of bithalamic gliomas is . To understand how a thalamic stroke affects the body, it helps to look at what a stroke is and what functions the thalamus controls. The other nine cases had bilateral paramedian thalamic lesions; seven developed bilateral dyskinesias, and the remaining two had unilateral dyskinesias. Most of the cases of thalamic stroke were associated with infarcts in other territories (60.7%), whereas isolated lesions were only present in 39.3% of cases. deep cerebral vein thrombosis and dural venous sinus thrombosis: internal cerebral veins. Retrospective analyses of the case records of 9 cases of bilateral thalamic lesions treated in our department . Bilateral damage of the thalamus has been found to invariably cause memory deficits [4] [6]. Bilateral thalamic gliomas represent a small subset of primary thalamic gliomas, accounting for an estimated 1-1.5% of all brain tumors [2]. Bilateral thalamic lesions are uncommon. In our case, the right cortical-subcortical lesion has an MRI initially showed high signals bilaterally in thalamus on T2-weighted (A), fluid-attenuated inversion recovery (B), and diffusion-weighted images (C), and apparent diffusion coefficient map (D). The limited differential diagnosis of bilateral thalamic lesions can be further narrowed with knowledge of the specific imaging characteristics of the lesions in combination [ajronline.org] However, the 15 patients reported here had astasia related to unilateral thalamic lesions , documented by autopsy and computed tomography in 2 patients and . Thalamic Blood Supply and Vascular Syndromes. The paramedian part of the thalamus is supplied . 35. G.P. 18-27. Bilateral thalamic lesions have a poorer neurobehavior-al prognosis than unilateral one. • Magnetic resonance imaging is essential in the diagnosis and reveals a hypo-intense to an iso-intense lesion on T1-weighted images and a hyper-intense lesion on T2/fluid-at-tenuated inversion recovery images. Typically, expansion of both thalami is ac- companied by abnormal hyperintensity on Hyperorality is part of the Kluver-Bucy syndrome which occurs in patients with bilateral mesial temporal lesions.1 We report a patient in whom compulsive hyperphagia was associated with a medial thalamic ischaemic stroke. After the administration of intravenous methylprednisolone pulse therapy, his symptoms improved with complete recovery from SIADH and regression of the hypothalamic and anterior thalamic lesions. This article will explain just that, along with an overview of the recovery process. may manifest as bilateral thalamic lesions (1). Chil- dren typically have signs of increased intra- cranial pressure and movement disorders. goal is complete occlusion15. These tumors are very rare and account for a small minority of brain tumors in children and young adults. No patients with a lesion restricted to the thalamus had a severe impairment in arousal (coma or stupor). This included patients with bilateral paramedian infarction having disorder of consciousness, memory dysfunctions, various types of vertical gaze palsy and psychic changes. Despite a similar, bilateral involvement of the thalamus, the use of connectivity-based segmentation clarified that R.F.'s lesions only were located within nuclei highly connected with the prefrontal cortical areas, thus explaining the patient's frontal syndrome. During the follow-up, repeated brain MRI showed complete disappearance of abnormalities in one patient and a small residual left thalamic lesion in the other. Bilateral thalamic gliomas represent a small subset of primary thalamic gliomas, accounting for an estimated 1-1.5% of all brain tumors [2]. Bilateral thalamic lesions Menon, G.; Nair, S.; Sudhir, J.; Rao, B.R.M. • Bilateral thalamic gliomas are extremely rare brain tumors, with typical symptoms of personality changes and memory impairment. Regarding the 19 patients with dystonia, the two with bilateral blepharospasm had thalamic and upper brainstem lesions, and one with hemidystonia and torticollis had a subthalamic lesion. ; Krishnakumar, K. British Journal of Neurosurgery 24(5): 566-571 2010 ISSN/ISBN: 0268-8697 . 12 The subject was reevaluated by Percheron, 13-17 and subsequent reports helped to simplify the clinical-anatomic considerations. When the commitment is extended to the rostral . Unilateral thalamic lesions cause transient or permanent behavioral, sensory and oculomotor disturbances; bilateral lesions of thalamus result in more severe and longer lasting symptoms. 16: 277-85. The cause of this condition may relate to thrombosed straight sinus. Arch Neurol. Bilateral thalamic glioma has a poor prognosis due to the location of the lesions [ 2 ]. Email 13709204858@163.com. Severe thalamic injury can determine a particular type of vascular dementia affecting multiple network dysfunctions, considered the central role of thalamus as a hub for afferent and efferent stimuli. Furthermore, the most frequent pathologies leading to bilateral lesions of the thalamus will be described. Accordingly, review of clinical symptoms revealed a lateralization pattern for the neuropsychological symptoms thalamic aphasia, memory deficits, neglect, behavioral changes, and neurocognitive impairment, which were in 95% (20 of 21 patients) associated with left-sided ITS lesions. Acute bilateral paramedian thalamic infarct is a rare condition.

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