Paramedian thalamopeduncular infarction: Clinical syndromes and magnetic resonance imaging
- 1 August 1992
- journal article
- case report
- Published by Wiley in Annals of Neurology
- Vol. 32 (2) , 162-171
- https://doi.org/10.1002/ana.410320207
Abstract
We prospectively examined 11 patients with magnetic resonance imaging–documented infarction in the paramedian thalamopeduncular region, which is supplied by the superior mesencephalic and posterior thalamosubthalamic arteries. Variations in the size and rostral–caudal extent of infarction correlated with the following three clinical patterns: (1) With unilateral paramedian mesencephalic infarction, an ipsilateral third nerve paresis was accompanied by mild contralateral hemiparesis or hemiataxia. Contralateral ptosis and impaired upgaze were observed in two patients; one of them showed additional damage to the posterior commissure. (2) With bilateral infarction in the thalamopeduncular junction, involving the mesencephalic reticular formation, supranuclear vertical gaze defects were accompanied by impaired consciousness or memory, and mild aphasia in some patients. Persistent amnesia was observed only when the dominant anterior nucleus or mamillothalamic tract was damaged. (3) With larger thalamopeduncular infarcts, partial or complete third nerve paresis was combined with supranuclear gaze disturbance and delayed contralateral tremor. An unusual gaze disorder, a variant of the vertical “one‐and‐a‐half syndrome,” occurred with a small strategically placed lesion at the thalamopeduncular junction, best explained by selective damage to supranuclear pathways or partial nuclear involvement. The primary cause of these infarctions was embolism to the basilar apex or local atheroma at the origin of the posterior cerebral artery.Keywords
This publication has 34 references indexed in Scilit:
- Diencephalic amnesia: a reorientation towards tracts?Brain Research Reviews, 1988
- The paramedian diencephalic syndrome: a dynamic phenomenon.Stroke, 1987
- Vertical gaze ophthalmoplegia from infarction in the area of the posterior thalamo-subthalamic paramedian artery.Stroke, 1986
- The syndrome of unilateral tuberothalamic artery territory infarction.Stroke, 1986
- Pupil sparing in oculomotor palsy: A brief reviewAnnals of Neurology, 1983
- PARINAUD'S SYNDROMEBrain, 1982
- Paramedian thalamic and midbrain infarcts: Clinical and neuropathological studyAnnals of Neurology, 1981
- DOWNWARD GAZE IN MONKEYSBrain, 1979
- Vertical oculomotor apraxia and memory lossAnnals of Neurology, 1978
- BILATERAL OPHTHALMOPLEGIA IN BASILAR-VERTEBRAL ARTERY DISEASEBrain, 1965