Bithalamic Infarct Revisited: Clinical, Imaging, Neuropsychological Profile and Prognosis
Clinical Neurology and Neuroscience
Volume 4, Issue 3, September 2020, Pages: 44-50
Received: Jun. 8, 2020;
Accepted: Jun. 19, 2020;
Published: Jul. 4, 2020
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Thierry Adoukonou, Service de Neurologie CHU Limoges, Limoges, France; Unité d’Enseignement et de Recherche de Neurologie, Faculté de Médecine Université de Parakou, Parakou, Benin
Mendinatou Agbétou, Unité d’Enseignement et de Recherche de Neurologie, Faculté de Médecine Université de Parakou, Parakou, Benin
Raphaël Kaboré, Service de Neurologie CHU Limoges, Limoges, France
Frédéric Faugeras, Service de Neurologie CHU Limoges, Limoges, France
Francisco Macian-Montoro, Service de Neurologie CHU Limoges, Limoges, France
Jean-Michel Vallat, Service de Neurologie CHU Limoges, Limoges, France
Laurent Magy, Service de Neurologie CHU Limoges, Limoges, France
The bilateral thalamic infarcts are a particular entity by their clinical presentations, neuropsychological, etiologic and prognostic. We report here the presentations of 19 consecutive cases collected at University Teaching Hospital of Limoges. All patients underwent clinical evaluation, neuropsychological (only some of them), a diagnostic imaging and a full workup. A follow-up was performed for certain patients These 19 patients including 11 women, mean age 65.6 years (+/- 14.0 years), 13 were hypertensive. Clinically 84.2% had oculomotor disorders and 73.7% of vigilance disorders. Seven patients had motor problems that have persisted for two days in one. In territorial terms, 17 had bilateral paramedian infarction including 10 with a stem associated injury; 1 patient had a heart attack in the paramedian and tubero-thalamic territory and the last patient had tubero-thalamic and thalamo-geniculated infarction. On the etiological among the stroke patients bithalamique paramedian, 9 patients had a disease of the small arteries and March 1 cardioembolic infarction. Neuropsychological disorders in patients examined were marked by disorder of episodic memory, working, executive dysfunction, speech disorders. After a mean follow up of 35 months and among all patients with bilateral thalamic stroke 5 patients had died. Our series confirms some data in the literature on the evolution of these heart attacks and suggests that they are mainly topography paramedian, due to small artery disease and have a particular neuropsychological outcome.
Bithalamic Infarct Revisited: Clinical, Imaging, Neuropsychological Profile and Prognosis, Clinical Neurology and Neuroscience.
Vol. 4, No. 3,
2020, pp. 44-50.
Dejerine J, Roussy G. Le syndrome thalamique. Rev neurol 1906; 14: 521-32.
Percheron G. Les artères du thalamus humain. Les artères choroïdiennes. Etude macroscopique des variations individuelles et systématisation. Rev Neurol (Paris) 1976; 132: 309-24.
Schmahmann JD. Vascular syndromes of the thalamus. Stroke. 2003; 34 (9): 2264-78.
Carrera E, Michel P, Bogousslavsky J. Anteromedian, central, and posterolateral infarcts of the thalamus: three variant types. Stroke. 2004; 35 (12): 2826-31.
Kumral E, Evyapan D, Balkir K, Kutluhan S. Bilateral thalamic infarction. Clinical, etiological and MRI correlates. Acta Neurol Scand. 2001; 103 (1): 35-42.
Monet P, Garcia PY, Saliou G, Spagnolo S, Desblache J, Franc J, Vallée JN, Deramond H, Lehmann P. Bithalamic infarct: is there an evocative aspect? Radioclinical study. Rev Neurol (Paris). 2009; 165 (2): 178-84.
Bogousslavsky J, Regli F, Uske A. Thalamic infarcts: clinical syndromes, etiology and prognosis. Neurology 1988; 38: 837-48.
Bogousslavsky J, Regli F, Delaloye B, Delaloye-Bischof A, Assal G, Uske A. Loss of psychic self-activation with bithalamic infarction. Neurobehavioural, CT, MRI and SPECT correlates. Acta Neurol Scand. 1991; 83 (5): 309-16.
Gentilini M, De Renzi E, Crizi G. Bilateral parmedian thalamic artery infarcts: report of eight cases. J Neurol Neurosurg Psychiatry 1987; 50: 900-9.
van Domburg PH, ten Donkelaar HJ, Notermans SL. Akinetic mutism with bithalamic infarction. Neurophysiological correlates. J Neurol Sci. 1996; 139 (1): 58-65.
Carrera E, Bogousslavsky. The thalamus and behavior. Neurology 2006; 66: 1817-23.
Koutsouraki E, Xiromerisiou G, Costa V, Baloyannis S. Acute bilateral thalamic infarction as a cause of acute dementia and hypophonia after occlusion of the artery of Percheron. J Neurol Sci. 2009; 283 (1-2): 175-7.
Engelborghs S, Marien P, Pickut BA, Verstraeten S, De Deyn PP. Loss of psychic self-activation after paramedian bithalamic infarction. Stroke 2000; 31 (7): 1762-5.
Adams HP Jr, Bendixen BH, Kappelle IJ et al. Classification of subtypes of stroke of acute ischemic stroke: definitions for use in a multicenter clinical trial. Stroke 1993; 23: 35-41.
Castaigne P, Lhermitte F, Buge A, Escourolle R, Hauw JJ, Lyon-Caen O. Paramedian thalamic and midbrain infarct: clinical and pathological study. Ann Neurol 1981; 10: 127-48.
Petit H, Rousseaux M, Clarisse J, Delafosse A. Oculocephalomotor disorders and thalamo-subthalamic infarction. Rev Neurol 1981; 137: 709-22.
Ocariz MNS, Nader JA, Santos JA, Bautista M. Thalamic vascular lesions. Risk factors and clinical course and infarcts and hemorrhages. Stroke 1996; 27: 1530-6.
Perren F, Clarke S, Bogousslavsky J. The syndrome of combined polar and paramedian thalamic infarction. Arch Neurol. 2005; 62: 1212-1216.
Aggleton JP, Saunders RC. The relationships between temporal lobe and diencephalic structures implicated in anterograde amnesia. Memory 1997; 5: 49-71.
Van der Werf YD, Witter PM, Uyslings HBM, Jolles J. Neuropsychology of infarctions in the thalamus: a review. Neuropsychologia 2000; 38: 613–27.
Bogousslavsky J, Regli F, Assal G. The syndrome of unilateral tuberothalamic artery territory infarction. Stroke 1986; 17: 434–441.
Cole M, Winkelman MD, Morris JC, Simon JE, Boyd TA. Thalamic amnesia: Korsakoff syndrome due to left thalamic infarction. J Neurol Sci 1992; 110: 62-7.
Ghika-Schmid F, Bogousslavsky J. The acute behavioral syndrome of anterior thalamic infarction: a prospective study of 12 cases. Ann Neurol 2000; 48: 220–227.
Sandson TA, Daffner KR, Carvalho PA, Mesulam MM. Frontal lobe dysfunction following infarction of the left-sided medial thalamus. Arch Neurol 1991; 48: 1300–3.
Daum I, Ackermann H. Frontal-type memory impairment associated with thalamic damage. Int J Neurosci 1994; 77: 187–198.
Williams PL, WarwickR, Dyson M, Bannister LH (eds) Grays Anatomy. Thirty seventh ed. Churchill Livingstone, Edinburgh, London, Melbourne and New York 1989; 999–1004.
Levasseur M, Baron JC, Sette G, Legault-Demare F, Pappata S, Mauguiere F, Benoit N, Tran SD, Degos SD, Laplane D, Mazoyer B. Brain energy metabolism in bilateral paramedian thalamic infarcts. A positron emission tomography study. Brain 1992; 115: 795–807.