Paramedian thalamopeduncular infarction

Clinical syndromes and magnetic resonance imaging

T. K. Tatemichi, W. Steinke, C. Duncan, Jacqueline A. Bello, J. G. Odel, M. M. Behrens, S. K. Hilal, J. P. Mohr

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

We prospectively examined 11 patients with magnetic resonance imaging-documented infarction in the paramedian thalamopeduncular region, which is supplied by the superior mesencephalic and posterior thalamosubthalamic arteries. Variations in the size and rostral-caudal extent of infarction correlated with the following three clinical patterns: (1) With unilateral paramedian mesencephalic infarction, an ipsilateral third nerve paresis was accompanied by mild contralateral hemiparesis or hemiataxia. Contralateral ptosis and impaired upgaze were observed in two patients; one of them showed additional damage to the posterior commissure. (2) With bilateral infarction in the thalamopeduncular junction, involving the mesencephalic reticular formation, supranuclear vertical gaze defects were accompanied by impaired consciousness or memory, and mild aphasia in some patients. Persistent amnesia was observed only when the dominant anterior nucleus or mamillothalamic tract was damaged. (3) With larger thalamopeduncular infarcts, partial or complete third nerve paresis was combined with supranuclear gaze disturbance and delayed contralateral tremor. An unusual gaze disorder, a variant of the vertical "one-and-a-half syndrome," occurred with a small strategically placed lesion at the thalamopeduncular junction, best explained by selective damage to supranuclear pathways or partial nuclear involvement. The primary cause of these infarctions was embolism to the basilar apex or local atheroma at the origin of the posterior cerebral artery.

Original languageEnglish (US)
Pages (from-to)162-171
Number of pages10
JournalAnnals of Neurology
Volume32
Issue number2
StatePublished - Aug 1992
Externally publishedYes

Fingerprint

Infarction
Magnetic Resonance Imaging
Paresis
Posterior Cerebral Artery
Amnesia
Aphasia
Tremor
Atherosclerotic Plaques
Embolism
Consciousness
Arteries

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Tatemichi, T. K., Steinke, W., Duncan, C., Bello, J. A., Odel, J. G., Behrens, M. M., ... Mohr, J. P. (1992). Paramedian thalamopeduncular infarction: Clinical syndromes and magnetic resonance imaging. Annals of Neurology, 32(2), 162-171.

Paramedian thalamopeduncular infarction : Clinical syndromes and magnetic resonance imaging. / Tatemichi, T. K.; Steinke, W.; Duncan, C.; Bello, Jacqueline A.; Odel, J. G.; Behrens, M. M.; Hilal, S. K.; Mohr, J. P.

In: Annals of Neurology, Vol. 32, No. 2, 08.1992, p. 162-171.

Research output: Contribution to journalArticle

Tatemichi, TK, Steinke, W, Duncan, C, Bello, JA, Odel, JG, Behrens, MM, Hilal, SK & Mohr, JP 1992, 'Paramedian thalamopeduncular infarction: Clinical syndromes and magnetic resonance imaging', Annals of Neurology, vol. 32, no. 2, pp. 162-171.
Tatemichi TK, Steinke W, Duncan C, Bello JA, Odel JG, Behrens MM et al. Paramedian thalamopeduncular infarction: Clinical syndromes and magnetic resonance imaging. Annals of Neurology. 1992 Aug;32(2):162-171.
Tatemichi, T. K. ; Steinke, W. ; Duncan, C. ; Bello, Jacqueline A. ; Odel, J. G. ; Behrens, M. M. ; Hilal, S. K. ; Mohr, J. P. / Paramedian thalamopeduncular infarction : Clinical syndromes and magnetic resonance imaging. In: Annals of Neurology. 1992 ; Vol. 32, No. 2. pp. 162-171.
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