Dejerine-Roussy syndrome or thalamic pain syndrome is characterized by numbness in the affected side followed by burning and tingling sensations, allodynia, and pain without external stimuli [54].

Thalamic stroke syndromes are usually rare because of multiple anastomoses from perforators of the anterior and the posterior circulation. Primary intraparenchymal thalamic hemorrhage occurs in the thalamus in 10–20% of cases. Secondary thalamic hemorrhage is often the result of chronic hypertension [55]. The artery of Percheron is a solitary arterial trunk that arises from one of the proximal segments of a posterior cerebral artery and supplies the paramedian thalami and the rostral midbrain bilaterally. Occlusion of this artery causes bilateral infarction in the paramedian portion of the thalamus, also known as an artery of Percheron infarct [56]. Occlusion of the posterior choroidal artery causes an infarction of the posterior thalamus as well as infarction of the lateral geniculate body, pulvinar, hippocampus, and parahippocampal gyrus, without involvement of the midbrain and the anterior nucleus of thalamus [57]. Finally, deep venous sinus (straight sinus) thrombosis can cause bilateral thalamic infarctions. Symptoms are acute of headache, conscious disturbances, and memory impairment [55].

A number of metabolic diseases are associated with basal ganglia lesions. Fabry disease is a multisystem X-linked disorder characterized by defect of lysosomal storage due to alpha-galactosidase A gene mutation. Hyperintensity on the pulvinar on T1-weighted images is a pathognomonic sign of the disease; it reflects the presence of calcification and other mineralizing alterations. Wilson disease, Leigh disease, Krabbe disease, maple syrup urine disease, Canavan disease, Alexander disease, and gangliosidosis can affect the thalamus [58].

Osmotic demyelinating syndrome is associated with electrolyte alterations, usually as complication of the rapid correction of hyponatremia. It has been associated with a variety of other conditions such as chronic alcoholism and malnutrition. Symptoms are quadriparesis and neurocognitive changes [59].

Wernicke’s encephalopathy is a pathological condition caused by deficiency of vitamin B1. It is characterized by consciousness alterations, ophthalmoplegia, and ataxia. Lesions are localized in the hypothalamus, dorsomedial nucleus of the thalamus, and mammillary bodies [60].

Creutzfeldt-Jakob disease is a fatal neurodegenerative disorder caused by prions (self-replicating proteinaceous infectious particles) and characterized by progressive dementia, myoclonus, coma, and death. It involves the basal ganglia, cerebral cortex, and thalamus and typically presents with the “pulvinar sign” on MRI (restricted diffusion in the medial pulvinar nuclei) [61].