Abstract

Bilateral paramedian thalamic infarction (BPTI) is rare. The most frequent clinical manifestations are acute impairment of consciousness, oculomotor abnormalities and cognitive disturbances. The paramedian thalamus is believed to play an important role in the regulation of sleep, and disturbances of sleep regulation are known to occur in paramedian thalamic stroke. We present a case of a 70-year-old man with a BPTI seen on magnetic resonance imaging. Initial neurological examination revealed severe hypersomnia, apathy, poor motivation, dysphagia, mild aphasia, and vertical gaze paresis. He had a past history of arterial hypertension. The patient had no focal motor deficits and improved slowly over 2 months of therapy. Right cardiac dilatation was detected on echocardiography; with an atrial fibrillation on electrocardiography. Biochemical studies revealed high serum triglyceride level. Finally, acute bilateral thalamic infarctions are often associated with specific neurologic-neuropsychological patterns, and the main cause is mainly small artery disease due to atheromatous occlusion of the paramedian thalamic penetrating artery.