Long term neurological sequela of isolated infarctions according to the topographic areas of thalamus (original) (raw)

2021, TURKISH JOURNAL OF MEDICAL SCIENCES

Introduction Thalamus plays a role in many high-level neurological functions, including the transfer of sensory and motor signals to the cerebral cortex, regulation of consciousness, sleep and wakefulness. Classical areas of thalamus are anterior, paramedian, inferolateral and posterior areas [1,2]. However, with the development of imaging methods, it has been reported that there are also variational areas. These areas are 1) Anteromedian region: defined as the infarctions including the posterior of the anterior region and anterior of the paramedian region. 2) Central region: The region which is defined with the inclusion of parts of four adjacent regions in the middle part of the thalamus. 3) Posterolateral region: It is defined as the area connecting the posterior part of the inferolateral region and the anterior of the posterior region. Thalamus is fed by four arteries (polar, thalamoperforating, thalamogeniculate, and posterior choroidal arteries) and the topographic regions of the thalamic infarctions are classically classified according to the watershed area of these four arteries. Variative areas are considered to develop as a result of anatomical variation of these arteries or border zone infarcts [3,4]. Thalamus contains many nuclei, and these nuclei are affected at various rates according to vascular lesions. Patients who admitted to the hospital with thalamus infarction may apply with hemiparesis, hemihypoesthesia, visual field defect, consciousness disorders, sleep disorders, neuropsychiatric findings. Information about the topographic area lesions of the thalamus and their clinical correlations develop after postthalamotomy or with infarction area-clinical finding correlations [5]. Because of the complex nucleus structure and arterial variations, information about thalamus needs to be increased in order Background/aim: Thalamus infarctions presented with various clinical findings are considered to be related to classical and variative infarction areas. In our study, we aimed to compare the sequela clinical findings of patients with isolated thalamus infarction according to anatomical areas. Materials and methods: Seventy patients diagnosed with isolated thalamus infarction in our clinic between 2010 and 2020 were included in the study. The infarction areas of the patients were divided into groups by the radiologist, including the variative areas to the classical areas using magnetic resonance imaging. Neurological examinations were performed and recorded. Sequela clinical findings of the groups were compared. Results: The mean age of all patients was 64.49 ± 13.75 (range between: 33-81) years, and the female ratio was 52.9% (n: 33). Inferolateral area infarction was detected most commonly. The most common complaints were sensory complaints (48.6%), speech disorders (20%), limb weakness (15.7%). There were no significant association between the neurological examination findings of classical and variative area infarctions of patients whose most common admission complaint is sensory deficits (p < 0.05), and significant signs of cognitive impairment were detected in the anterior area compared to other areas (p < 0.001). It can be considered that cognitive impairment we detected in the anterior area developed due to its associations. Conclusion: In our study where sequela findings were evaluated, the absence of a significant difference in neurological examination findings can be explained by the decline of many acute clinical findings over time.