Thalamic Infarctions: A Case Study of Inferolateral and Posterior Choroidal Branch Involvement in a Patient Without Classic Vascular Risk Factors.

Abstract

Introduction: Thalamic infarctions represent a rare subset of ischemic strokes, characterized by a diverse array of clinical manifestations and significant diagnostic challenges. These infarctions can lead to a wide range of neurological deficits, depending on the specific vascular territory involved. Infarctions within the posterior circulation territory of P2, particularly those affecting the inferolateral and posterior choroidal arteries, are associated with distinct neurological symptoms, including contralateral sensory loss, hemiparesis, hemiataxia, thalamic hand, and various sensory and motor disturbances.

Case report: We present the case of a 47-year-old woman with a unilateral thalamic infarction involving occlusion of the P2 branch of the posterior cerebral artery. The infarction, caused by a paradoxical embolism secondary to a high-grade patent foramen ovale (PFO) with an interatrial septal aneurysm, occurred in the absence of classic vascular risk factors. The patient exhibited a clinical syndrome consistent with ischemic lesions in the inferolateral and posterior choroidal arteries, manifesting as right-sided hemiparesthesia, hemiataxia with neuropathic pain, thalamic hand, dystonia, and tremor in the upper right limb.

Conclusion: Early and precise clinical identification of thalamic infarctions, especially in rare cases involving multiple vascular territories, is essential for improving patient care and outcomes. Recognizing the spectrum of potential symptoms facilitates effective symptom management, minimizes the risk of secondary complications, and optimize neurological rehabilitation.