Unilateral Thalamic Lesion



Unilateral Thalamic Lesion


Karen L. Salzman, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Lacunar Infarction


  • Hypertensive Intracranial Hemorrhage


  • Neurofibromatosis Type 1


Less Common



  • Diffuse Astrocytoma, Low Grade


  • Glioblastoma Multiforme


  • Anaplastic Astrocytoma


  • ADEM


Rare but Important



  • Multiple Sclerosis


  • Thrombosis, Deep Cerebral Venous


  • Germinoma


ESSENTIAL INFORMATION


Helpful Clues for Common Diagnoses



  • Lacunar Infarction



    • Small, < 1.5 cm T2 hyperintensity in thalamus or basal ganglia (BG)


    • DWI restriction if acute


    • Related to ischemia of penetrating vessels


  • Hypertensive Intracranial Hemorrhage



    • BG > thalamus > pons/cerebellum > hemisphere bleed in a hypertensive patient


    • 15-25% in thalamus


    • May enhance subacutely


    • Intraventricular hemorrhage common


  • Neurofibromatosis Type 1



    • Focal areas of signal intensity (FASI) in deep gray matter characteristic (60-85%)


    • Globus pallidus, white matter (WM), thalami, hippocampi, brainstem


    • Bilateral > > unilateral


    • No enhancement!


Helpful Clues for Less Common Diagnoses



  • Diffuse Astrocytoma, Low Grade



    • Nonenhancing T2 hyperintense mass


    • May be bilateral


  • Glioblastoma Multiforme



    • Peripherally enhancing WM mass typical


    • May involve thalamus or BG


  • Anaplastic Astrocytoma



    • T2 hyperintense mass ± enhancement


  • ADEM



    • Multifocal WM &/or BG lesions following infection/vaccination


    • Thalamic involvement common


    • Typically bilateral, but asymmetric lesions


Helpful Clues for Rare Diagnoses

Tags:
Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Unilateral Thalamic Lesion

Full access? Get Clinical Tree
Get Clinical Tree app for offline access