Sheikh Hassan Mohamed, Osman Sidow Nor, Mohamed Ali Abdiladhif, Osman Mohamed Farah, Ahmed Ibrahim Abdiwahid, Abdirahman Ahmed Said
Department of Neurology Mogadishu Somalia Turkish Training and Research Hospital Mogadishu Somalia.
Department of Cardiology Mogadishu Somalia Turkish Training and Research Hospital Mogadishu Somalia.
Clin Case Rep. 2023 Jun 19;11(6):e7590. doi: 10.1002/ccr3.7590. eCollection 2023 Jun.
Bilateral thalamic infarction in paramedian artery territory may present with severe acute illness, confusion, coma and memory impairment. However, subtle clinical presentation as in our case should alert the clinician to consider such a diagnosis as it can be associated with good prognosis.
Bilateral thalamic infarct is a rare form of stroke. Mostly thalamic infarcts are unilateral. In most cases, bilateral thalamic infarction leads to cognitive dysfunction, opthalmoparesis, conscious impairment, behavioral disturbance, and corticospinal dysfunction. Here, we describe the case of a 75-year-old male patient who presented to the emergency department of our hospital with agitation and somnolence for one day. He had poorly controlled hypertension. There was no previous history of stroke, diabetes mellitus, hyperlipidemia, known cardiac disease, or smoking history. There was no seizure, recent headache, or visual disturbance. The patient was somnolent and not oriented to time, person, or place. Neurological examination did not show any focal weakness or vertical eye movement restrictions. Other systemic examinations, including those of the respiratory and cardiovascular systems, were unremarkable. Extensive laboratory investigations excluded potential metabolic, infectious, endocrine, or toxic etiologies. The patient did not have any recent history of drug misuse, including benzodiazepines. Brain MRI with diffusion-weighted imaging showed an acute bilateral thalamic infarct. Cerebral angiography was unremarkable. The patient was treated with low molecular weight heparin 60 mg subcutaneously, aspirin 300 mg daily, and haloperidol 5 mg twice daily for agitation. After two weeks of intrahospital treatment, his condition improved (consciousness and orientation massively improved).
双侧丘脑旁正中动脉供血区梗死可能表现为严重急性病、意识模糊、昏迷和记忆障碍。然而，如我们病例中的轻微临床表现应提醒临床医生考虑此类诊断，因为其预后可能良好。
双侧丘脑梗死是一种罕见的中风形式。大多数丘脑梗死为单侧性。在大多数情况下，双侧丘脑梗死会导致认知功能障碍、眼球运动麻痹、意识障碍、行为紊乱和皮质脊髓功能障碍。在此，我们描述一例75岁男性患者，因烦躁和嗜睡1天就诊于我院急诊科。他的高血压控制不佳。既往无中风、糖尿病、高脂血症、已知心脏病或吸烟史。无癫痫发作、近期头痛或视觉障碍。患者嗜睡，对时间、人物或地点无定向力。神经系统检查未发现任何局灶性无力或垂直眼球运动受限。包括呼吸和心血管系统在内的其他全身检查无异常。广泛的实验室检查排除了潜在的代谢、感染、内分泌或中毒病因。患者近期无药物滥用史，包括苯二氮䓬类药物。弥散加权成像的脑部MRI显示急性双侧丘脑梗死。脑血管造影无异常。患者接受了皮下注射低分子肝素60mg、每日口服阿司匹林300mg以及每日两次口服氟哌啶醇5mg以控制烦躁。住院治疗两周后，他的病情有所改善（意识和定向力大幅改善）。
