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Pure sensory stroke with lacunar infarction in the posterior ventral thalamus on CT
Pure sensory stroke with lacunar infarction in the posterior ventral thalamus on CT E.L. Gorsselink*
and J. Ladder*
Introduction Summary In the few cases of pure sensory stroke that came to autopsy, Fisher found small ischemic lesions in the posteroventral thalamus’J. He, therefore, suggested that small lacunar infarcts in this nucleus are the most probable cause of pure sensory stroke. Although pure sensory stroke is one of the most prevalent lacunar syndromes:‘, in only one case a single lacunar infarct restricted to the thalamus was detected by CT4. We report a second case of pure sensory stroke with a lacunar infarct in the posterior area of the ventral thalamus on CT.
numbness hand.
Case history
Discussion
A 68year-old hypertensive male visited neurlogical out-patients’ clinic because
the one
week previously he suddenly experienced a feeling of numbness and a burning sensation, in the left side of his body except for his face. There was no previous history of focal cerebrovascular attacks or amaurosis fugax. Neurological examination revealed decreased perception of pinprick on the left side, sparing the face. No other abnormalities were found, such as signs of higher cortical dysfunction. Both plain CT and CT with contrast revealed a small hypodense area in the posterior ventral thagralamus (Fig. 1). The patients’ symptoms dually decreased. although one month later
A hypertensive male patient is described who suffered a pure sensory stroke. CT revealed a small lacunar infarct in the contralateral posterior part of the ventral thalamus. This is the second described case with a CT verified single ischemic lesion restricted to the thalamus. Key words: cerebra-vascular
diseases, lacunar
infarcts
was still present
in the left arm and
In a personal series of 58 patients with the lacunar syndrome of pure sensory stroke Fisher5 found none with lacunar infarct on CT. and he concluded that infarcts that cause this condition are too small to be visualized by CT. However, a few cases with positive CT findings have been published. Nelson et al6 found two patients with pure sensory stroke; one with a large lacunar infarct of 5.8 ml that probably was not restricted to the thalamus, and one with ‘bilateral lacunar infarcts’ in whom the exact location was not mentioned. Rosenberg and KollerT reported a patient with a small lacunar thalamic infarct who additionally suffered a larger cortical infarction in the posterior
patient
with a small infarct within
of the thalamus. Our patient
also
suffered
the boundary
a pure
sensor!
stroke caused by a small iacunar infarct in the posterior region of the ventral thalamus. This location is compatible with the autopsy findings of Fisher’,‘. Detection of ischemic lesions in patients increase
with pure sensory stroke will probably with increased resolution capacity of
modern CT scanners, and possibly also with NMR scanning. Because of the low number of autopsy
verified
cases. such increase
in lesion
detection standing
during life will add to the underof this intriguing syndrome.
References CM. Pure sensory stroke involving face. arm and leg. Neurology 1965; 15:76. FISHER CM. Thalmamic pure sensory stroke: A pathological study. Neurology 1978; 28: 1141. FISHER CM. Thalamic pure sensory stroke: A pathoNeurology 1982; 32:871. LANDS G. ANZALONE N. VACCARI u. CT scan evidence of posterolateral thalamic infarction in pure sensory stroke. Neurol Neurosurg Psychiatry 1984; 47:570. I-ISHER c M. Pure sensory stroke and allied conditions. Stroke 1982: 13:434. NELSON RF. PUUICINO P. KENDALL BE e/ u/. Computed tomography in patients presenting with lacunar syw dromes. Stroke 1980: I l:256. ROSENBERG NI.,KOLLER R. Computerized tomography and pure sensory stroke. Neurology 1981: 31:217. WEISBERG LA. Lacunar infarcts. Clinical and computed tomographic correlations. Arch Neurol 1982: 39:37. FISHER
l’lg. I C‘T scan of a patient with pure sensory woke. cuttmg through the basal thalamus and showing a small hypodenac arca (arrow) in the posterior part of the thalamu<
cerebral artery region. A second patient had multiple lacunar infarcts with supposed damage to the thalamic-cortical pathway. Weisbergs mentioned two patients with pure sensory stroke and positive CT findings. However, the lacunar infarcts were not restricted to the thalamus. Recently Landi et a14. reported a
46
and J. Ladder*
Introduction Summary In the few cases of pure sensory stroke that came to autopsy, Fisher found small ischemic lesions in the posteroventral thalamus’J. He, therefore, suggested that small lacunar infarcts in this nucleus are the most probable cause of pure sensory stroke. Although pure sensory stroke is one of the most prevalent lacunar syndromes:‘, in only one case a single lacunar infarct restricted to the thalamus was detected by CT4. We report a second case of pure sensory stroke with a lacunar infarct in the posterior area of the ventral thalamus on CT.
numbness hand.
Case history
Discussion
A 68year-old hypertensive male visited neurlogical out-patients’ clinic because
the one
week previously he suddenly experienced a feeling of numbness and a burning sensation, in the left side of his body except for his face. There was no previous history of focal cerebrovascular attacks or amaurosis fugax. Neurological examination revealed decreased perception of pinprick on the left side, sparing the face. No other abnormalities were found, such as signs of higher cortical dysfunction. Both plain CT and CT with contrast revealed a small hypodense area in the posterior ventral thagralamus (Fig. 1). The patients’ symptoms dually decreased. although one month later
A hypertensive male patient is described who suffered a pure sensory stroke. CT revealed a small lacunar infarct in the contralateral posterior part of the ventral thalamus. This is the second described case with a CT verified single ischemic lesion restricted to the thalamus. Key words: cerebra-vascular
diseases, lacunar
infarcts
was still present
in the left arm and
In a personal series of 58 patients with the lacunar syndrome of pure sensory stroke Fisher5 found none with lacunar infarct on CT. and he concluded that infarcts that cause this condition are too small to be visualized by CT. However, a few cases with positive CT findings have been published. Nelson et al6 found two patients with pure sensory stroke; one with a large lacunar infarct of 5.8 ml that probably was not restricted to the thalamus, and one with ‘bilateral lacunar infarcts’ in whom the exact location was not mentioned. Rosenberg and KollerT reported a patient with a small lacunar thalamic infarct who additionally suffered a larger cortical infarction in the posterior
patient
with a small infarct within
of the thalamus. Our patient
also
suffered
the boundary
a pure
sensor!
stroke caused by a small iacunar infarct in the posterior region of the ventral thalamus. This location is compatible with the autopsy findings of Fisher’,‘. Detection of ischemic lesions in patients increase
with pure sensory stroke will probably with increased resolution capacity of
modern CT scanners, and possibly also with NMR scanning. Because of the low number of autopsy
verified
cases. such increase
in lesion
detection standing
during life will add to the underof this intriguing syndrome.
References CM. Pure sensory stroke involving face. arm and leg. Neurology 1965; 15:76. FISHER CM. Thalmamic pure sensory stroke: A pathological study. Neurology 1978; 28: 1141. FISHER CM. Thalamic pure sensory stroke: A pathoNeurology 1982; 32:871. LANDS G. ANZALONE N. VACCARI u. CT scan evidence of posterolateral thalamic infarction in pure sensory stroke. Neurol Neurosurg Psychiatry 1984; 47:570. I-ISHER c M. Pure sensory stroke and allied conditions. Stroke 1982: 13:434. NELSON RF. PUUICINO P. KENDALL BE e/ u/. Computed tomography in patients presenting with lacunar syw dromes. Stroke 1980: I l:256. ROSENBERG NI.,KOLLER R. Computerized tomography and pure sensory stroke. Neurology 1981: 31:217. WEISBERG LA. Lacunar infarcts. Clinical and computed tomographic correlations. Arch Neurol 1982: 39:37. FISHER
l’lg. I C‘T scan of a patient with pure sensory woke. cuttmg through the basal thalamus and showing a small hypodenac arca (arrow) in the posterior part of the thalamu<
cerebral artery region. A second patient had multiple lacunar infarcts with supposed damage to the thalamic-cortical pathway. Weisbergs mentioned two patients with pure sensory stroke and positive CT findings. However, the lacunar infarcts were not restricted to the thalamus. Recently Landi et a14. reported a
46