Thalamic Stroke: Presentation and Prognosis of Infarcts and Hemorrhages

Wolfgang Steinke, Ralph L. Sacco, J. P. Mohr, Mary A. Foulkes, Thomas K. Tatemichi, Philip A. Wolf, Thomas R. Price, Daniel B. Hier

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Abstract

Thalamic strokes in 62 patients selected from the Stroke Data Bank were studied to determine differences among 18 infarctions (INF), 23 localized hemorrhages (ICH), and 21 hematomas with ventricular extension (IVH). Stupor or coma at onset occurred more frequently in the IVH (62%) than in the INF (6%) or ICH (13%) groups and was reflected in significantly lower median Glasgow Coma Scores in the IVH group (7) than in the INF (15) and ICH (14) groups. Although ocular movements were more frequently abnormal in the IVH group compared with the ICH and INF groups, no significant differences were found in the frequency of motor or sensory deficits. Among the 62 strokes, 32 had restricted lesions of the posterolateral (n=9), anterior (n=3), paramedian (n=7), and dorsal (n=13) portions of the thalamus. Differences in consciousness and in motor, sensory, and oculomotor deficits were found among the topographic subgroups. Stroke-related deaths occurred in 52% of IVH cases, 13% of ICH cases, and no cases of INF. Median lesion volume as detected with computed tomography was greater in hemorrhages (INF, 2 cm3; ICH, 10 cm3; IVH, 16 cm3), with mortality related to increasing hematoma size. Coma, Glasgow Coma Score lower than 9, weakness score greater than 15 of a possible 30, abnormal ocular movements, and fixed pupils were also associated with stroke-related mortality. We conclude that the initial neurologic syndrome does not discriminate infarcts from intrathalamic hemorrhages. Ventricular extension, however, causes significantly more severe deficits and higher mortality.

Original languageEnglish (US)
Pages (from-to)703-710
Number of pages8
JournalArchives of neurology
Volume49
Issue number7
DOIs
StatePublished - Jul 1992
Externally publishedYes

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ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

Cite this

Steinke, W., Sacco, R. L., Mohr, J. P., Foulkes, M. A., Tatemichi, T. K., Wolf, P. A., Price, T. R., & Hier, D. B. (1992). Thalamic Stroke: Presentation and Prognosis of Infarcts and Hemorrhages. Archives of neurology, 49(7), 703-710. https://doi.org/10.1001/archneur.1992.00530310045011