Bilateral thalamic lesions: a pictorial essay

Nikolaos Achilleas Arkoudis, Dimitrios K Filippiadis, Panagiotis Toulas, Georgios Velonakis

Abstract


The aim of this pictorial review is to familiarize radiologists with the numerous pathologies that can affect bilateral thalami while demonstrating their several neuroimaging manifestations. Vascular etiologies include infarcts of the artery of Percheron, tip of the basilar syndrome, venous infarcts, hypoxic-ischemic encephalopathy, PRES, hypertensive microbleeds, and CADASIL; infectious etiologies include Creutzfeldt-Jakobs disease and encephalitides, while demyelinating disorders include ADEM and MS. Bilateral thalamic involvement may also be seen in metabolic & toxic etiologies such as Wernicke encephalopathy, osmotic myelinolysis, Fabry disease, Fahr disease, Wilson disease, and Leigh disease. Furthermore, low- and high-grade gliomas may originate or infiltrate bilateral thalami while gadolinium deposition can be a mimicker of disease. Radiological features that can be used in the assessment and differential approach include MR signal characteristics, calcifications, exact location within the thalamus, symmetry, presence of synchronous extra-thalamic involvement, and presence of expansion. Additional imaging tools such as DWI, MRA/MRV/CTA/CTV, MRS, PWI, and correlation with clinical and laboratory findings may narrow the differential diagnosis.


Keywords


Thalamic; Bilateral; Basal ganglia; Central Nervous System; CNS; Radiology; CT; MRI; Diagnostic; Imaging;

Full Text:

PDF

References


Li S, Kumar Y, Gupta N, et al. Clinical and Neuroimaging Findings in Thalamic Territory Infarctions: A Review. J Neuroimaging. 2018;28(4):343-349. doi:10.1111/jon.12503

Lazzaro NA, Wright B, Castillo M, et al. Artery of Percheron infarction: imaging patterns and clinical spectrum. AJNR Am J Neuroradiol. 2010;31(7):1283-1289. doi:10.3174/ajnr.A2044

Ahn SH, Kim BJ, Kim YJ, Kang DW, Kwon SU, Kim JS. Patterns and Outcomes of the Top of the Basilar Artery Syndrome: The Role of the Posterior Communicating Artery. Cerebrovasc Dis. 2018;46(3-4):108-117. doi:10.1159/000492059

Poon CS, Chang JK, Swarnkar A, Johnson MH, Wasenko J. Radiologic diagnosis of cerebral venous thrombosis: pictorial review. AJR Am J Roentgenol. 2007;189(6 Suppl):S64-S75. doi:10.2214/AJR.07.7015

Ganeshan D, Narlawar R, McCann C, Jones HL, Curtis J. Cerebral venous thrombosis-A pictorial review. Eur J Radiol. 2010;74(1):110-116. doi:10.1016/j.ejrad.2009.02.007

Lövblad KO, Bassetti C, Schneider J, Ozdoba C, Remonda L, Schroth G. Diffusion-weighted MRI suggests the coexistence of cytotoxic and vasogenic oedema in a case of deep cerebral venous thrombosis. Neuroradiology. 2000;42(10):728-731. doi:10.1007/s002340000395

Huang BY, Castillo M. Hypoxic-ischemic brain injury: imaging findings from birth to adulthood. Radiographics. 2008;28(2):417-617. doi:10.1148/rg.282075066

McKinney AM, Short J, Truwit CL, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189(4):904-912. doi:10.2214/AJR.07.2024

Tuttle C, Boto J, Martin S, et al. Neuroimaging of acute and chronic unilateral and bilateral thalamic lesions. Insights Imaging. 2019;10(1):24. Published 2019 Feb 22. doi:10.1186/s13244-019-0700-3

Stojanov D, Vojinovic S, Aracki-Trenkic A, et al. Imaging characteristics of cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL). Bosn J Basic Med Sci. 2015;15(1):1-8. doi:10.17305/bjbms.2015.247

Hegde AN, Mohan S, Lath N, Lim CC. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics. 2011;31(1):5-30. doi:10.1148/rg.311105041

Fragoso DC, Gonçalves Filho AL, Pacheco FT, et al. Imaging of Creutzfeldt-Jakob Disease: Imaging Patterns and Their Differential Diagnosis. Radiographics. 2017;37(1):234-257. doi:10.1148/rg.2017160075

Tschampa HJ, Mürtz P, Flacke S, Paus S, Schild HH, Urbach H. Thalamic involvement in sporadic Creutzfeldt-Jakob disease: a diffusion-weighted MR imaging study. AJNR Am J Neuroradiol. 2003 May;24(5):908-15. PMID: 12748093.

Renard D, Castelnovo G, Campello C, et al. Thalamic lesions: a radiological review. Behav Neurol. 2014;2014:154631. doi:10.1155/2014/154631

Smith AB, Smirniotopoulos JG, Rushing EJ, Goldstein SJ. Bilateral thalamic lesions. AJR Am J Roentgenol. 2009;192(2):W53-W62. doi:10.2214/AJR.08.1585

Linn, J., Danek, A., Hoffmann, L.A. et al. Differential Diagnosis of Bilateral Thalamic Lesions. Clin Neuroradiol 17, 3–22 (2007). doi: 10.1055/s-2007-962857

Moore DF, Ye F, Schiffmann R, Butman JA. Increased signal intensity in the pulvinar on T1-weighted images: a pathognomonic MR imaging sign of Fabry disease. AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1096-101. PMID: 12812932.

Lidove O, Klein I, Lelièvre JD, et al. Imaging features of Fabry disease. AJR Am J Roentgenol. 2006;186(4):1184-1191. doi:10.2214/AJR.05.0019

Yu XE, Gao S, Yang RM, Han YZ. MR Imaging of the Brain in Neurologic Wilson Disease. AJNR Am J Neuroradiol. 2019;40(1):178-183. doi:10.3174/ajnr.A5936

Douis H, Jafri M, Sherlala K. Bilateral thalamic glioma. Arch Neurol. 2008;65(12):1666-1667. doi:10.1001/archneur.65.12.1666

Kang H, Hii M, Le M, et al. Gadolinium Deposition in Deep Brain Structures: Relationship with Dose and Ionisation of Linear Gadolinium-Based Contrast Agents. AJNR Am J Neuroradiol. 2018;39(9):1597-1603.




DOI: http://dx.doi.org/10.36162/hjr.v6i3.434

Refbacks

  • There are currently no refbacks.