Bilateral Thalamic Infarctions Due to Occlusion of the Paramedian Artery
- Paramedian artery arises from the P1 segment of the posterior cerebral artery and supplies the dorsomedial nucleus, internal medullary lamina, and the central laminar nuclei. Occasionally, it can also supply the ventral and anterior thalamic nuclei (region supplied by the tuberothalamic artery) as seen in the current case.
- Patients with paramedian thalamic infarctions are often obtunded, comatose, or agitated, and they may or may not have associated hemiplegia or hemisensory loss. Occasionally, the cranial nerve III nucleus is involved with resultant ophthalmoplegia.
- DDx: includes Percheron artery infarction and "top of the basilar artery" syndrome.
- DDx: for bilateral thalamic lesions also includes bilateral internal cerebral vein thrombosis, lymphoma, and glioma.
