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Open Access 01-12-2021 | Stroke | Research article

Isolated thalamic stroke – analysis of clinical characteristics and asymmetry of lesion distribution in a retrospective cohort study

Authors: Martin A. Schaller-Paule, Ariane Martinez Oeckel, Jan-Rüdiger Schüre, Fee Keil, Elke Hattingen, Christian Foerch, Maximilian Rauch

Published in: Neurological Research and Practice | Issue 1/2021

Abstract

Background

More patients with left-hemispheric than right-hemispheric strokes are admitted to hospitals. This is due to the easier recognition of cortical symptoms of the dominant-hemisphere. The thalamus constitutes a “micro-model” of the brain cortex with structure-function relationships known to be asymmetric, especially for language, memory, and visuo-spatial neurocognitive functions. The goal of this study was to characterize clinical symptoms and lesion distribution patterns of patients with acute isolated thalamic stroke (ITS) and to evaluate whether left-sided lesions are overrepresented in the hospital.

Methods

We performed a radiological database search including all brain scans performed in the Center of Neurology and Neurosurgery of the University Hospital Frankfurt between 2010 and 2019. A total of 5733 patients presenting with acute ischemic stroke were screened for ITS. Based on the MRI data, a lesion-overlap map was then generated to visualize the ITS lesion distribution.

Results

Fifty-eight patients with unilateral ITS were identified. A majority of 38 patients (65.5%) showed left-sided ITS, whereas only 20 patients (34.5%) had right-sided ITS (p = 0.012). A particular difference was found for ITS lesions in the anterior thalamus of the anterolateral (n = 10) and anteromedian (n = 3) vascular territory, which were located in the left thalamus in 85% of patients (p = 0.011). No distribution difference was found for ITS lesions in the inferomedial (n = 7), central (n = 8), inferolateral (n = 23) and posterior (n = 7) vascular territories. The neuropsychological symptoms of thalamic aphasia (n = 8), neurocognitive impairment (n = 6), behavioral changes (n = 2), neglect (n = 2) and memory deficits (n = 3) were described predominantly in patients with left-sided ITS (p < 0.01). In contrast, other stroke symptoms (e.g., sensorimotor hemi-syndromes) did not reveal a side preponderance.

Conclusions

The better recognizability of left anterior compared to right anterior thalamic stroke symptoms may have an impact on the frequency in which ITS patients are admitted to the hospital. Clinical characteristics of right anterior thalamic stroke should therefore be further investigated, and diagnostic instruments towards their detection be identified.

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Title: Isolated thalamic stroke – analysis of clinical characteristics and asymmetry of lesion distribution in a retrospective cohort study
Authors: Martin A. Schaller-Paule
Ariane Martinez Oeckel
Jan-Rüdiger Schüre
Fee Keil
Elke Hattingen
Christian Foerch
Maximilian Rauch
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Stroke
Aphasia
Published in: Neurological Research and Practice / Issue 1/2021
Electronic ISSN: 2524-3489
DOI: https://doi.org/10.1186/s42466-021-00148-7

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Springer Medicine

Isolated thalamic stroke – analysis of clinical characteristics and asymmetry of lesion distribution in a retrospective cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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