This Article Full Text Full Text (PDF) All Versions of this Article: 34/9/2264    most recent 01.STR.0000087786.38997.9Ev1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schmahmann, J. D. Search for Related Content PubMed PubMed Citation Articles by Schmahmann, J. D. Related Collections Behavioral/psychosocial - stroke Acute Cerebral Infarction Acute Stroke Syndromes Behavioral Changes and Stroke Cerebral Lacunes

(Stroke. 2003;34:2264.)
© 2003 American Heart Association, Inc.

Comments, Opinions, and Reviews

Vascular Syndromes of the Thalamus

From the Department of Neurology, Massachusetts General Hospital, Boston.

Correspondence to Jeremy D. Schmahmann, MD, Department of Neurology, VBK 915, Massachusetts General Hospital, Fruit St, Boston, MA 02114. E-mail jschmahmann{at}partners.org

Background— This article reviews the anatomy, connections, and functions of the thalamic nuclei, their vascular supply, and the clinical syndromes that result from thalamic infarction.

Summary of Review— Thalamic nuclei are composed of 5 major functional classes: reticular and intralaminar nuclei that subserve arousal and nociception; sensory nuclei in all major domains; effector nuclei concerned with motor function and aspects of language; associative nuclei that participate in high-level cognitive functions; and limbic nuclei concerned with mood and motivation. Vascular lesions destroy these nuclei in different combinations and produce sensorimotor and behavioral syndromes depending on which nuclei are involved. Tuberothalamic territory strokes produce impairments of arousal and orientation, learning and memory, personality, and executive function; superimposition of temporally unrelated information; and emotional facial paresis. Paramedian infarcts cause decreased arousal, particularly if the lesion is bilateral, and impaired learning and memory. Autobiographical memory impairment and executive failure result from lesions in either of these vascular territories. Language deficits result from left paramedian lesions and from left tuberothalamic lesions that include the ventrolateral nucleus. Right thalamic lesions in both these vascular territories produce visual-spatial deficits, including hemispatial neglect. Inferolateral territory strokes produce contralateral hemisensory loss, hemiparesis and hemiataxia, and pain syndromes that are more common after right thalamic lesions. Posterior choroidal lesions result in visual field deficits, variable sensory loss, weakness, dystonia, tremors, and occasionally amnesia and language impairment.

Conclusions— These vascular syndromes reflect the reciprocal cerebral cortical-thalamic connections that have been interrupted and provide insights into the functional properties of the thalamus.

Key Words: cerebral cortex • cognition • diaschisis • language • memory • thalamus

This article has been cited by other articles:

				G. T. Stebbins, D. L. Nyenhuis, C. Wang, J. L. Cox, S. Freels, K. Bangen, L. deToledo-Morrell, K. Sripathirathan, M. Moseley, D. A. Turner, et al. Gray Matter Atrophy in Patients With Ischemic Stroke With Cognitive Impairment Stroke, March 1, 2008; 39(3): 785 - 793. [Abstract] [Full Text] [PDF]

				G.-q. Fei, C. Zhong, L. Jin, J. Wang, Y. Zhang, X. Zheng, Y. Zhang, and Z. Hong Clinical Characteristics and MR Imaging Features of Nonalcoholic Wernicke Encephalopathy AJNR Am. J. Neuroradiol., January 1, 2008; 29(1): 164 - 169. [Abstract] [Full Text] [PDF]

				M. K. Houtchens, R.H.B. Benedict, R. Killiany, J. Sharma, Z. Jaisani, B. Singh, B. Weinstock-Guttman, C. R.G. Guttmann, and R. Bakshi Thalamic atrophy and cognition in multiple sclerosis Neurology, September 18, 2007; 69(12): 1213 - 1223. [Abstract] [Full Text] [PDF]

				E. Kumral, H. Gulluoglu, and B. Dramali Thalamic chronotaraxis: isolated time disorientation J. Neurol. Neurosurg. Psychiatry, August 1, 2007; 78(8): 880 - 882. [Abstract] [Full Text] [PDF]

				K. Mondon, I. Bonnaud, S. Debiais, P. Brunault, D. Saudeau, B. de Toffol, and A. Autret Abrupt onset of disturbed vigilance, bilateral third nerve palsy and masturbating behaviour: a rare presentation of stroke Emerg. Med. J., August 1, 2007; 24(8): 600 - 601. [Abstract] [Full Text] [PDF]

				S. Weidauer, H. Lanfermann, A. Raabe, F. Zanella, V. Seifert, and J. Beck Impairment of Cerebral Perfusion and Infarct Patterns Attributable to Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Prospective MRI and DSA Study Stroke, June 1, 2007; 38(6): 1831 - 1836. [Abstract] [Full Text] [PDF]

				R. Rahme, R. Moussa, A. Awada, I. Ibrahim, Y. Ali, J. Maarrawi, T. Rizk, G. Nohra, N. Okais, and E. Samaha Acute Korsakoff-Like Amnestic Syndrome Resulting from Left Thalamic Infarction Following a Right Hippocampal Hemorrhage AJNR Am. J. Neuroradiol., April 1, 2007; 28(4): 759 - 760. [Abstract] [Full Text] [PDF]

				K. Ito, R. Ishida, Y. Akamatsu, E. Ogata, and T. Nito Successful Cochlear Implantation in a Patient With Bilateral Thalamic Infarction Arch Otolaryngol Head Neck Surg, February 1, 2007; 133(2): 192 - 193. [Full Text] [PDF]

				A. Le Guyader, K. Nubret, N. Darodes, and M. Laskar Removal of a ventricular mitral valve fibroelastoma by an aortic approach Interactive CardioVascular and Thoracic Surgery, December 1, 2006; 5(6): 785 - 787. [Abstract] [Full Text] [PDF]

				S. Giannopoulos, V. Kostadima, A. Selvi, P. Nicolopoulos, and A. P. Kyritsis Bilateral Paramedian Thalamic Infarcts Arch Neurol, November 1, 2006; 63(11): 1652 - 1652. [Full Text] [PDF]

				C M Bird, P Malhotra, A Parton, E Coulthard, M F S Rushworth, and M Husain Visual neglect after right posterior cerebral artery infarction J. Neurol. Neurosurg. Psychiatry, September 1, 2006; 77(9): 1008 - 1012. [Abstract] [Full Text] [PDF]

				E. Carrera and J. Bogousslavsky The thalamus and behavior: Effects of anatomically distinct strokes Neurology, June 27, 2006; 66(12): 1817 - 1823. [Abstract] [Full Text] [PDF]

				A. S. Mitchell and J. C. Dalrymple-Alford Lateral and anterior thalamic lesions impair independent memory systems. Learn. Mem., May 1, 2006; 13(3): 388 - 396. [Abstract] [Full Text] [PDF]

				J. Andrews, L. Wang, J. G. Csernansky, M. H. Gado, and D. M. Barch Abnormalities of Thalamic Activation and Cognition in Schizophrenia Am J Psychiatry, March 1, 2006; 163(3): 463 - 469. [Abstract] [Full Text] [PDF]

				C. Zhong, L. Jin, and G. Fei MR Imaging of Nonalcoholic Wernicke Encephalopathy: A Follow-Up Study AJNR Am. J. Neuroradiol., October 1, 2005; 26(9): 2301 - 2305. [Abstract] [Full Text] [PDF]

				A C Kneebone, M A Luszcz, R A Baker, and J L Knight A syndromal analysis of neuropsychological outcome following coronary artery bypass graft surgery J. Neurol. Neurosurg. Psychiatry, August 1, 2005; 76(8): 1121 - 1127. [Abstract] [Full Text] [PDF]

				C. Bellebaum, I. Daum, B. Koch, M. Schwarz, and K.-P. Hoffmann The role of the human thalamus in processing corollary discharge Brain, May 1, 2005; 128(5): 1139 - 1154. [Abstract] [Full Text] [PDF]

				E. Carrera, P. Michel, and J. Bogousslavsky Anteromedian, Central, and Posterolateral Infarcts of the Thalamus: Three Variant Types Stroke, December 1, 2004; 35(12): 2826 - 2831. [Abstract] [Full Text] [PDF]