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[Bithalamic infarct: is there an evocative aspect? Radioclinical study].

P Monet¹, P-Y Garcia, G Saliou

¹Service de neuroradiologie, CHU d'Amiens, 1 Place Victor-Pauchet, 80054 Amiens Cedex 1, France.

Revue Neurologique

|November 15, 2008

Summary

Bithalamic paramedian infarcts, though rare, cause complex syndromes. Awareness of this diagnosis is crucial, even with mild consciousness fluctuations like hypersomnia.

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Area of Science:

Neurology
Neuroanatomy
Vascular Neurology

Background:

Bithalamic paramedian infarcts are uncommon cerebrovascular events.
These infarcts result from occlusion of a single thalamic paramedian artery, often due to an anatomical variant of the artery's origin.

Observation:

Four cases of bithalamic paramedian infarcts are presented.
Clinical presentations included vertical gaze palsy, memory impairment, confusion, and coma, though rarely in combination.
All patients experienced episodes of drowsiness or hypersomnia.

Findings:

The underlying anatomy involves an asymmetrical common trunk for the thalamosubthalamic paramedian arteries (Percheron classification type IIb).
Literature review (1985-2006) identified frequent clinical signs: vertical gaze palsy (65%), memory impairment (58%), confusion (53%), and coma (42%).
Anatomy-function correlations explain the varied clinical manifestations.

Implications:

Clinicians should consider bithalamic paramedian infarcts in patients with altered consciousness, including hypersomnia.
Neuroimaging confirmation is essential for diagnosis.
Understanding this condition aids in interpreting complex stroke syndromes.