Delayed Unilateral Akathisia with Posterior Thalamic Infarct

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Abstract
We report a patient with a small infarct in the posterior thalamic nuclei involving the pulvinar, probably in the territory of the lateral branches of the left posterior choroidal artery, who first presented with acute right sensorimotor stroke, followed 5 months later by a kinesigenic pain on the same side, which evolved in a few weeks toward a painless urge to move (hemiakathisia). There was a good response to a short trial of clonazepam. Posterior thalamic nuclei are at a crossroad between sensory inputs to the ventroposterolateral nuclei and motor efferent ones from the cerebellum and internal pallidum in their way back to the secondary motor areas, and lesions in this region could possibly induce plastic changes evolving to misdirection or cross-talk of sensory and motor information responsible for involuntary hyperkinetic movement disorders. This unique case report lends strong support to a causal role of sensory deficits in the occurrence of some movement disorders.

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