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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.
Background:
Bilateral thalamic infarction, especially the medial thalamus, has been characteristically described in the artery of Percheron (AOP) affection. However, bilateral thalamic restriction has been described in many entities beyond the AOP infarction.
Objective:
Here we describe a case series (three cases) with infection as an etiology for bilateral thalamic lesions in the topographic distribution of the AOP from a tertiary care center in tropical India.
Materials And Methods:
: Case series during a 1-year period collecting cases with bilateral thalamic diffusion restriction on MRI who did not have thalamic infarcts and their outcomes.
Results:
: Bilateral thalamic lesion can occur in both bacterial and viral infections such as tuberculosis, dengue, and SARS-COV-2. Thus, we intend to add infections as one of the etiologies in the ever-expanding list of conditions that produce bilateral thalamic restriction.
Conclusions:
All the acute symmetric thalamic lesions are not always secondary to vascular insult. Accurate assessment and prompt diagnosis can prevent unnecessary delays in treatment. To our knowledge, this is the first case series in the literature that throws light on the bilateral thalamic lesions in the topographic distribution of the AOP secondary to infections in a tropical country like India.
Insights
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.
