Anteromedian, central, and posterolateral infarcts of the thalamus - Three variant types
Anteromedian, central, and posterolateral infarcts of the thalamus - Three variant types
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DOI：
10.1161/01.str.0000147039.49252.2f
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发表时间：
2004-12-01
期刊：
影响因子：
8.3
通讯作者：
Bogousslavsky, J
中科院分区：
文献类型：
--
作者：
Carrera, E;Michel, P;Bogousslavsky, J
背景和目的-丘脑梗死传统上分为4个区域：前部、旁正中、下外侧和后部。本研究的目的是审查这一经典与变异分布在丘脑stroks. Methods患者，我们回顾了所有患者的第一个临床中风包括在1990年至2002年之间的洛桑中风登记。在71例经MRI证实的丘脑孤立性急性卒中患者中，我们选择了所有经典区域外病变的患者，并研究了其临床、病因学和放射学特征。（所有丘脑卒中患者的30%）显示出典型区域外的梗死，使我们能够描绘出3种变异分布：（1）前正中区（9例患者[13%]），累及前正中区和旁正中区，主要伴有认知障碍，包括执行功能障碍、顺行性遗忘和左侧或双侧病变中的失语症。最常见的卒中机制是心源性栓塞。(2)中央区域（4例患者[6%]），丘脑中央部分病变，导致各种神经和神经心理学体征，反映了几个相邻结构的受累。微血管病变是最常见的病因。(3)后外侧区（8例患者[11%]），涉及下外侧区和后外侧区，最常见的表现为偏侧感觉减退，其次为偏侧共济失调、执行功能障碍和左侧病变失语。动脉-动脉栓塞和微血管病变是主要的中风mechanism. Conclusions，我们描述了3种不同的地形图的丘脑梗死与不同的表现和病因。我们推测这些梗死是丘脑动脉供应变化的结果，或者反映了边缘区缺血。
Background and Purpose-Thalamic infarcts have traditionally been classified into 4 territories: anterior, paramedian, inferolateral, and posterior. The purpose of this study was to review this classical versus variant distribution in patients with thalamic stroke.Methods-We reviewed all patients with a first clinical stroke included in the Lausanne Stroke Registry between 1990 and 2002. Among 71 patients with an acute stroke isolated to the thalamus confirmed by MRI, we selected all patients with lesions outside the classical territories and studied their clinical, etiological, and radiological features.Results-A total of 21 patients (30% of all thalamic stroke patients) showed infarction outside the classical territories, allowing us to delineate 3 variant distributions: (1) Anteromedian territory (9 patients [13%]) involving anterior and paramedian territories, with predominantly cognitive impairment, including executive dysfunction, anterograde amnesia, and aphasia in left-sided or bilateral lesions. The most frequent stroke mechanism was cardiac embolism. (2) Central territory (4 patients [6%]), with lesions on the central part of the thalamus, resulting in a variety of neurological and neuropsychological signs, reflecting the involvement of several adjacent structures. Microangiopathy was the most frequent etiology. (3) Posterolateral territory (8 patients [11%]), involving inferolateral and posterior territories, with hemihypesthesia as the most frequent manifestation, followed by hemiataxia, executive dysfunction, and aphasia in left-sided lesions. Artery-to-artery embolism and microangiopathy were the main stroke mechanisms.Conclusions-We describe 3 variant topographic patterns of thalamic infarction with distinct manifestations and etiologies. We postulate that these infarcts are the result of a variation in thalamic arterial supply or reflect border-zone ischemia.