Clinical And Imaging Analysis Of Bilateral Thalamic Lesions

Objective:To analyze the etiology of bilateral thalanic lesions,clinical symptoms,imaging features,diagnosis and prognosis.To improve the clinical doctors’understanding of bilateral thalamic lesions,providing help for diagnosis and treatment in clinical work.Methods:From September 2011 to February 2017,We collected 50 patients with bilateral thalamic lesions in the No.1 Hospital of Jilin University.we collected the clinical data of the patients according to the different causes.The clinical manifestations,imaging features,diagnosis and prognosis were classified,and the characteristics of different lesions of bilateral thalamic were summarized.Results:(1)In general The 50 patients consisted of 22 males and 28 females in our study,The average age was 48.08±18.30 years(ranged from 13 to 77 years).(2)Etiology Vascular diseases in 29 cases(58%):17 case of artery infarction,9 cases of venous infarct and thalamus hemorrhage in 2 cases,the central variant of Posterior reversible encephalopathy syndrome in 1 case;6 cases of Metabolic diseases(12%)(Wernicke’s Encephalopathy);Hereditary diseases in 5 cases(10%):4 cases of the Wilson’s Disease,adrenoleukody-strophy(ALD)in 1 case;Infectious diseases in 4 cases(8%):the eningoence-phalitis caused by cytomegalovirus(CMV)in 1 case,the possible epidemic encephalitis B in 3 cases;demyelinating disorders in 2 cases(4%),the acute disseminated encephalomyelitis(ADEM)in 1 case,multiple sclerosis(MS)in 1 case;Related immune diseases in 3 patients(6%),1 case of brainstem encephalitis,autoimmune encephalitis in 1 case,neuropsychiatric systemic lupus erythematosus(NPSLE)in 1 case;the probably lymphoma in 1 case(2%).(3)Clinical manifestation 39 patients presented with consciousness dysfunction,including somnolence,stupor,various coma,confusion;22 patients presented with speech disturbances,dyskinesia in 20 patients,cognitive impairment in 19 cases,13 patients presented with mental symptoms,ocular motility disorder in 14 cases,13 cases presented with abnormal pupil,10 cases presented with headache,extrapyramidal symptoms in 9 cases,seizures in 5 cases,ataxia in 3 cases,sensory disturbance in 1 case.(4)Characteristic imaging findings All patients had bilateral thalamic lesions on MRI which presented hyperintensity on T2WI and hypointensity on T1WI.15 cases of bilateral thalamic infarction were caused by Percheron artery occlusion,Midbrain involvement was seen in 8 cases,four of which had a“V”signal in midbrain,in the other 3 cases,the anterior thalamus was involved.Venous infarction showed hyperintensity on DWI that the edema of vascular origin was more obvious,3 cases of patients with MRI of the cerebral veins and sinus abnormalities,MRV showed deep venous thrombosis.CT can showed asymmetric high density image of thalamic hemorrhage,one patient with CTA showed Moya-Moya disease.In addition to bilateral thalamic lesions,similar MR signal were seen in the bilateral basal ganglia,brainstem and cerebellum for the central variant of Posterior reversible encephalopathy syndrome.In addition to the bilateral medial thalamus,aqueduct of midbrain,mammillary body,surrounding the third and four ventricle,hippocampus,basal ganglia involvement in Wernicke’s encephalopathy.Additional lesions can be seen in The caudate nucleus,putamen,globus pallidus,brainstem for Wilson’s disease.The typical imaging manifestation of ALD is the symmetrical distribution of white matter lesions in the lateral ventricle triangle area,including the brain stem,cerebellum and hippocampus.All of the patients were infected with viral infection,in addition to the symmetrical lesions of thalamus,basal ganglia,hippocampus and corpus callosum were involved.In patients with ADEM,the swelling of the thalamus was significantly associated with brainstem involvement.(5)Prognosis Mortality occurred in 3/50,of which ADEM in 1 cases and NPSLF in 1 case,the probably lymphoma in 1 case.Survival patients with poor prognosis often left varying degrees of awareness barriers,eye movement disorders,cognitive disorders,psychiatric symptoms,extrapyramidal symptoms.ConclusionThe etiology of bilateral thalamic lesions is complicated and various.Including almost all of common diseases of the central nervous system disease,such as vascular,infectious,metabolic,genetic,demyelinating and immune related diseases,In this study,the most common cause of bilateral thalamic lesions is vascular disease,and the most common type of vascular disease is arterial infarction.The imaging characteristics of bilateral thalamic lesions caused by different reasons have their own characteristics.It is of great significance to master the imaging features of common etiology in the diagnosis of bilateral thalamic lesions.