Clinical Features of a Bilateral Paramedian Thalamic Stroke

Patients with this type of stroke tend to have both paramedian thalamic arteries arising from the same (left or right) basilar communicating artery.

Neuroanatomical involvement: rostral interstitial nucleus of the medial longitudinal fasciculus; posterior internal medullary lamina; paraventricular medial, ventrolateral and centromedian nuclei of the thalamus

Clinical features:

(1) disturbed vigilance (drowsiness, hypersomnolence, episodic coma)

(2) vertical gaze paresis

(3) amnesic syndrome

(4) convergence difficulty

(5) third nerve palsy

(6) eyelid retraction

(7) dysarthria

(8) ataxia

(9) involuntary limb movements

Differential diagnosis:

(1) Wernicke-Korsakoff syndrome

(2) tumor or other lesions of the superior mesencephalon