Bithalamic Infarct Revisited: Clinical, Imaging, Neuropsychological Profile and Prognosis

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.