Thalamic stroke. Presentation and prognosis of infarcts and hemorrhages
W. Steinke, R. L. Sacco, J. P. Mohr, M. A. Foulkes, T. K. Tatemichi, P. A. Wolf, T. R. Price and D. B. Hier
Neurological Institute of New York, Columbia Presbyterian Medical Center, NY 10032.
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.
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