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Diffusion Restriction in Bilateral Thalami: Beyond Artery of Percheron Infarct
Reshma S Shaik1, Sandhya Manorenj1, Sravan K Marupaka2
1Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India.
Neurology India
|August 28, 2023
Summary
Infections, not just vascular issues like artery of Percheron (AOP) affection, can cause bilateral thalamic lesions. This study highlights infections as a key cause of these brain abnormalities.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Bilateral thalamic infarction, particularly medial thalamus, is often linked to artery of Percheron (AOP) issues.
- However, numerous conditions beyond AOP infarction can manifest as bilateral thalamic restriction on MRI.
Purpose of the Study:
- To investigate infections as an etiology for bilateral thalamic lesions within the AOP topographic distribution.
- To expand the known causes of bilateral thalamic restriction beyond vascular insults.
Main Methods:
- A case series of three patients with bilateral thalamic diffusion restriction on MRI was collected over one year.
- Cases excluded those with confirmed thalamic infarcts, focusing on non-vascular etiologies.
Main Results:
- Bilateral thalamic lesions were observed in patients with infections, including bacterial and viral etiologies like tuberculosis, dengue, and SARS-CoV-2.
- Infections are identified as a significant cause of bilateral thalamic lesions in the AOP distribution.
Conclusions:
- Acute symmetric thalamic lesions are not exclusively due to vascular events.
- Prompt diagnosis and assessment are crucial for effective treatment, as infections present similarly to vascular insults.
- This is the first case series to report bilateral thalamic lesions in the AOP distribution secondary to infections in India.
