Thalamic Infarct

Outline
• Function of thalamus
• Anatomy of thalamus
• Vascular supply
• Clinical features
Anatomy
• Gray matter
• ‘inner chamber’
in greek
Functions
• Arousal and nociception
• Sensory
• Motor and language
• Mood and motivation
• High level cognitive function
Subdivisions of thalamus
 Sensory
Subdivisions of thalamus information
Emotion +
recent
memory

Visual
attention

Hearing
consciousness consciousness
Motor
vision info
Blood supply
to thalamus
Tuberothalamic artery territory infarct
• Fluctuating arousal and orientation
• Memory  Impaired learning, memory, autobiographical memory,
Executive failure, perseveration
• Neuropsychiatric  Personality changes, apathy, abulia
• Left sided lesion - aphasia
• Right side  hemispatial neglect
Inferolateral artery territory infarct
• pure sensory stroke
• hemisensory deficit
• Sensorimotor 
• sensory disturbances are accompanied by motor abnormalities on the same
side
• Hemiataxia
• Dejerine Roussy
• post lesion pain
• Abnormal movements, such as hemidystonia and jerks in the hand,
can develop after several weeks. Dystonic hand
Paramedian artery territory infarct
• Decreased arousal
• Impaired learning and memory,
• confabulation, temporal disorientation, poor autobiographical
memory
• Vertical gaze impairment
• Aphasia if left sided
• spatial deficits if right sided
• Altered social skills and personality including apathy, aggression,
agitation
 Bilateral paramedian artery territory infarct

• Artery of Percheron 
normal anatomical variant
whereby a single unpaired
artery arise from P1 portion
of PCA to supply bilateral
paramedian thalami,
sometimes to rostral
midbrain
• Almost one-third of human
brains present this variant.
Bilateral paramedian thalamic
infarction in a patient with a
top of the basilar embolus
involving midbrain and
hypothalamus.
Bilateral paramedian artery territory infarct
• acutely ill and disorientation, confusion, hypersomnolence, deep
coma
• akinetic mutism (awake unresponsiveness)
• severe memory impairment with perseveration and confabulation are
prominent behavioral features, often accompanied by eye movement
abnormalities
• the late stages  inappropriate social behaviors, impulsive aggressive
outbursts, emotional blunting, loss of initiative, and a reported
absence of spontaneous thoughts or mental activities
Posterior choroidal artery territory infarct
• upper- and lower-quadrantanopia
• more typically, horizontal wedge-shaped or tubular sectoranopias
• Atypical symptoms include impairment of ipsilateral pursuit, contralateral
saccades
• mild hemiparesis or hemisensory
• dystonic movements
• neuropsychological disturbances such as aphasia, amnesia, abulia, and
visual hallucinations.
• jerky dystonic unsteady hand  delayed complex hyperkinetic motor
syndromes, associating ataxia, tremor, dystonia, myoclonus and chorea