Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...
Â
Thalamic infarction
1. THALAMIC VASCULAR
SYNDROMES
Chris Robinson, DO
Deparment of Neurology
Loyola University Medical Center
2012.
2. CASE
⢠58 y/o female driving w/ husband @ 9:30
AM w/ sudden onset blurred vision and
difficulty focusing.
⢠5 min later w/ R facial droop, somnolence,
aphasia and R hemiparesis
⢠Present to OSH at 10:05 AM
3. CASE
PMH/PSH:
1. Infiltrating DCIS s/p lumpectomy/radiation â 2006
2. Insomnia â 2006
3. Reported incidental heart murmur â 2007
Social Hx:
Tob â negative
ETOH â socially
Illicits â negative
Married
Speech/Language Pathologist
Family Hx:
CAD, Breast Cancer, Brother w/ brain aneurysm
5. CASE
Physical Exam:
VS: HR â 73 BP â 154/83 R â 14 O2- 98% RA
General Medical Exam â normal
Neurologic Exam
- NIHSS â 12
- 1- partial gaze palsy, 3 â b/l hemianopsia, 2 â partial facial
weakness, 1 â one limb ataxia, 2- severe sensory loss, 1 â mild
aphasia, 1 â mild dysarthria, 1- mild extinction
- Sx â binocular vertical diplopia, blurred vision, R facial droop, and R
sided weakness
- Pt recorded as alert, oriented, comprehensive, and w/out focal
motor weakness
6. CASE
Hospital Course:
Arrival â 9:30 AM
Examination â 10:05 AM
Pt w/ objective evidence of stroke and negative CTT for
bleed recieves IV Alteplase at 11:15 am and is
transferred to UMASS for neuro ICU care.
7. CASE
Arrival at UMASS â 8/11/2012
-NIHSS of 6 on arrival - records of exam not received â
known at that time pt had R sided facial droop and b/l
upward gaze palsy
Neurologic Exam -8/12/2012
-GCS â 15 (E-4,V-5,M-6), NIHSS â 0, b/l upper gaze
palsy (R>L) w/ binocular upper gaze diplopia, remainder of
neurologic exam normal.
Neurologic Exam -8/12/2012
- Neurologic exam within normal limits w/ no residual deficits
10. CASE
Radiology Cont:
MRI Brain â acute L thalamic infarction
CTA â No stenosis in the anterior or the posterior
circulation, small nodule L lobe of thyroid
TTE â evidence of ? ASD
11. Thalamic Blood Supply
⢠4 Major Vacular Territories
1. Tuberothalamic or Polar Artery
(PCOM)
2. Paramedian
(Basilar Communicating Artery
3. Inferolateral or Thalamogeniculate
(PCA)
4. Posterior Choroidal
(PCA)
15. Posterolateral Inarction
⢠Occlusion of thalamogeniculate a.
⢠P2 segment of PCA
⢠3 common clinical syndromes
1. Pure Sensory
2. Sensorimotor
3. Dejerine-Roussy - contralateral sensory, thalamic pain
of involved side, vasomotor disturbance, transient contralateral
hemiparesis, and mild hyperkinetic disturbances
16. Anterior Infarction
⢠Occlusion of polar or turberothalamic a.
⢠Branch of PCOM
⢠Clinical Manifestations
- Alteration in consciousness, abulia,
disorientation, personality disturbances, visual
field deficits
L sided â thalamic aphasia
R sided â hemineglect, alien hand
17. Paramedian Infarction
⢠Paramedian a. -
⢠Branch of basilar communication a.
â Basilar a. prior to ostium of PCOM
⢠Clinical Manifestations â somnolence, memory
loss, mood disturbances, vertical gaze
abnormalities
⢠Can be b/l â artery of percheron â
hypersomnolence and marked memory
impairment
18. Dorsal Infarction
⢠Posterior Choroidal a.
⢠Branch of P2 segment of PCA
⢠Clinical Manifestations â homonymous
quadrantanopia or homonymous
horizontal sectoranopias
â If pulvinar affected can have aphasia or
cardiac dysthymia's
20. Case
Plan:
-Pt d/c on zocor 40 mg daily and ASA 325
mg
-Presented to Neurology Clinic 8/22/2012 pt
continues to be asymptomatic
-Cont ASA and statin for now, 30 day ECAT
monitor, TEE