Recurrent pure sensory transient ischemic attacks: In vivo demonstration of associated thalamic infarction.
We present a case study and literature review to clarify the pathoanatomic substrate of recurrent pure sensory transient ischemic attacks (TIAs). A 60-year-old woman had had over 50 transient episodes of left hemibody hypoesthesia over the previous 15 years. Interictal neurologic examination was normal. Magnetic resonance imaging (MRI) showed a small infarct in the ventroposterolateral (VPL) nucleus of the right thalamus. Symptoms resolved with warfarin therapy. Ischemia-related pure sensory symptoms present as one of two clinical syndromes: (a) sudden onset of persistent unilateral face, arm, and/or leg hypoesthesia/paresthesias, preceded by no or few TIAs, or (b) frequent espisodes of transient unilateral hypoesthesia/paresthesias not progressing to permanent deficit. The first is widely recognized; recent computed tomography/MRI series have reported 105 cases associated with thalamic, brainstem, or thalamocortical projection sensory pathway infarction. Although equally common, the syndrome of recurrent transient hemihypoesthesia is under-recognized and has a less well-described pathologic substrate. One previous case with postmortem documentation of a VPL thalamic infarction has been reported. We believe this is the first reported case of recurrent transient hemihypoesthesia associated with VPL thalamic infarction imaged in vivo.
From the Department of Neurology, Stroke Program, Northwestern University Medical School, Chicago, IL.
E
E
Fernandez-Beer
The Dent Neurologic Institute, Millard Fillmore Hospital, Buffalo, NY, U.S.A.
J T
JT
Patrick
From the Department of Neurology, Stroke Program, Northwestern University Medical School, Chicago, IL.
J
J
Biller
From the Department of Neurology, Stroke Program, Northwestern University Medical School, Chicago, IL.
J L
JL
Saver