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Posterior Circulation Stroke pp 67–84Cite as

Thalamic and Other Posterior Cerebral Artery Stroke Syndromes

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Abstract

The posterior cerebral arteries (PCAs) are the terminal branches of the basilar artery and supply blood to the rostral midbrain, the thalamus, the occipital lobes, and part of the parietal and temporal lobes including the hippocampus. Classically, it has been distinguished a proximal or deep PCA territory (including the thalamus) and a distal or superficial PCA territory (including the occipital and temporoparietal lobes).

Posterior cerebral artery (PCA) territory infarctions represent 5–10% of all ischaemic strokes. Of these, the involvement of the thalamus has been reported up to 60–70% of patients, while pure superficial PCA strokes seem less frequent.

In this chapter, we reviewed the stroke syndromes related to thalamic infarctions and other PCA territory infarctions. Even if it can be difficult to determine the vascular territory of an acute posterior circulation stroke on purely clinical grounds, this knowledge may be useful to determine the most appropriate acute treatment and prevention strategy.

The clinical features of thalamic infarction vary according to the vascular topography. We describe the four classical stroke syndromes related to the anterior, paramedian, inferolateral and posterior thalamic infarctions, which correspond, respectively, to the vascular territory of the polar, paramedian, thalamogeniculate and posterior choroidal arteries. Inferolateral territory infarction is the most common type of thalamic infarction, and the main clinical features are hemisensory deficits. The main clinical features of anterior and paramedian territory infarctions are neuropsychiatric disturbances including somnolence, memory deficits, and visuospatial neglect.

The most important clinical feature of cortical PCA infarction is visual field defect, especially homonymous hemianopia. Memory deficits and visual-related cognitive dysfunction are also frequently encountered.

Outcome after PCA territory infarct is usually regarded as more favourable than in anterior circulation strokes, mostly due to lower mortality and lower incidence of motor deficits. However, in the long term, patients with thalamic strokes may be affected by sensory-related sequelae (including central pain syndrome) or cognitive disturbances, while visual field defect and neuropsychological deficits may remain as troublesome consequences in patients with superficial PCA strokes.

Keywords

  • Posterior cerebral artery
  • Thalamus
  • Visual field defects
  • Amnesia
  • Central pain

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Fig. 5.1
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  1. Stroke Centre, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland

    Stefania Nannoni & Patrik Michel

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  1. Department of Neurology Asan Medical Center, University of Ulsan, Seoul, Korea (Republic of)

    MD Jong S. Kim

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Nannoni, S., Michel, P. (2021). Thalamic and Other Posterior Cerebral Artery Stroke Syndromes. In: Kim, J.S. (eds) Posterior Circulation Stroke. Springer, Singapore. https://doi.org/10.1007/978-981-15-6739-1_5

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