Isolated bilateral thalamic infarction: an uncommon cause of coma
TSIVGOULIS G., LOUKAIDIS P., PAPAPOSTOLOU A., VASSILOPOULOU S., SPENGOS K.
We present the case of a 67-year old woman with intermittent atrial fibrillation, who was found unresponsive at her apartment and was admitted to our department with acute coma (Glasgow Coma Scale score of 6). The patient fully recovered consciousness on the third day of ictus and her neurological examination revealed apathy, indifference, impaired learning and memory and limitation of upward gaze. Acute simultaneous paramedian bilateral thalamic infarcts affecting reticular and intralaminar nuclei that subserve arousal and nociception were identified in brain MRI performed two weeks after symptom onset. In the present case we assume a cardioembolic etiopathogentic mechanism on the grounds of atrial fibrillation (insufficiently treated with antiplatelets) as the underlying mechanism of this variant form of a "top of the basilar syndrome", which constitutes an uncommon cause of coma.
Key words: Stroke, bilateral, thalamic, coma.