Diaschisis after thalamic stroke: a comparison of metabolic and structural changes in a patient with amnesic syndrome

Acta Neurol Scand Suppl. 2007;187:68-71. doi: 10.1111/j.1600-0404.2007.00851.x.

Abstract

Introduction: We present a patient with a left anteromedial thalamic lesion with an amnesic syndrome. The patient underwent neuropsychological testing, cerebrospinal fluid (CSF) analyses, magnetic resonance imaging (MRI) [T2, flair, and diffusion tensor imaging (DTI)] and [18F]-2-fluoro-deoxy-d-glucose positron emission tomography (FDG-PET) to assess indirect effects of thalamic lesions on cortical function.

Case report: A 67-year-old right-handed woman was admitted to a university-based memory unit because of memory and concentration problems. Neuropsychological testing revealed dysfunction of episodic memory, semantic memory and working memory. General intellectual function and attention capacity were preserved. MRI revealed an anteromedial thalamic lesion in the left hemisphere. FDG-PET showed decreased uptake in the frontal, parietal and temporal lobes of the left hemisphere. Regions of interest (ROI) in white matter were selected and left and right hemispheres were compared. Fractional anisotropy (FA) in ROI representing thalamo-cortical connections were decreased in the left hemisphere when compared with the right.

Conclusion: The results show the importance of a network that include the anterior and dorsomedian nuclei, which influence the activity in areas of the cortex responsible for memory processes. The imaging findings suggest that areas of cortical diaschisis after thalamic infarction correspond to areas affected by thalamo-cortical fibre loss as measured with FA.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Aged
  • Amnesia / diagnostic imaging
  • Amnesia / etiology*
  • Amnesia / physiopathology*
  • Anterior Thalamic Nuclei / diagnostic imaging
  • Anterior Thalamic Nuclei / pathology
  • Anterior Thalamic Nuclei / physiopathology
  • Cerebral Cortex / diagnostic imaging
  • Cerebral Cortex / physiopathology
  • Efferent Pathways / diagnostic imaging
  • Efferent Pathways / pathology
  • Efferent Pathways / physiopathology
  • Female
  • Fluorodeoxyglucose F18
  • Functional Laterality / physiology
  • Humans
  • Magnetic Resonance Imaging
  • Mediodorsal Thalamic Nucleus / diagnostic imaging
  • Mediodorsal Thalamic Nucleus / pathology
  • Mediodorsal Thalamic Nucleus / physiopathology
  • Memory / physiology
  • Memory Disorders / diagnostic imaging
  • Memory Disorders / etiology*
  • Memory Disorders / physiopathology*
  • Neuropsychological Tests
  • Positron-Emission Tomography
  • Radiography
  • Stroke / complications*
  • Stroke / diagnostic imaging
  • Stroke / physiopathology*
  • Thalamic Diseases / complications*
  • Thalamic Diseases / diagnostic imaging
  • Thalamic Diseases / physiopathology*
  • Thalamus / diagnostic imaging
  • Thalamus / pathology
  • Thalamus / physiopathology*

Substances

  • Fluorodeoxyglucose F18