Clinical Analysis Of 46 Cases Of Thalamic Infarction

ObjectiveTo explore the cause,risk factors, clinical manifestation and therapeutic effect of the different parts of the thalamus infarction, and deepen the understanding of the thalamus infarction.MethodsRetrospective analyses the cause, risk factors, the relationship between clinical manifestations and imaging features, prognosis of 46 patients with unilateral thalamic infarction among 2013-12-30 to 2015-11-03,to study the thalamic infaction according to the relationship between clinical manifestation and neuroanatomy.Results(1) In the 46 cases of unilateral isolated thalamus infarction, there are 2 anterolateral subtype(thalamotubercle artery supply area)(4.3%), 7 interior subtype(paramedian artery supply area)(15.2%), 35 posterolateral subtype(thalamogenilulate artery supply area)(71.7%), no dorsal subtype(posterior choroidal artery supply area),2 mixed subtype(1 involved the interior and posterolateral subtye, 1 involved the posterolateral and dorsal subtype).1 patient of thalamus anterolateral type have cognitive dysfunction, MMSE is 18,the main manifestations are slow to respond, stiff, calculative ability decline and ecmnesia.2 patients of the posterolateral subtype have cognitive dysfunction, mainly show is speech, expressive difficultly, but comprehension and reading ability are good.39 patients have contralateral limb hemiparesis, with lateral limb muscle strength for 4-5 grade, including 2 patients prior to admission with countermeasure limbs hemiplegia aggravating phenomenon.12 patients with the contralateral limb sensory disturbance, mainly the subjective sensation disturbance.10 patients appear dysarthria, mainly show is vague.1 patient has mental symptoms, characterized by self-talk, recite the textbook knowledge of all the subjects, but can answer simply.The etiology is cardiac embolism after the acute infective endocarditis.(2) In terms of etiology, 33 patients have small vessel disease, 8 patients have cardiac embolism, 4 patients have large vascular disease, 1 patient don’t know the etiology.(3) In terms of risk factors, the number of patients with type 2 diabetes is 8(17.4%), the number of patients with hypertension disease is 34(73.9%), the number of patients with hyperlipidemia is 18(39.1%), and the number of patients who smoke is 8(17.4%), none of them has migraine headaches, lack of vitamin B1, nerve lupus。(4) In terms of treatment, 3 patients have complications(6.5%), of which 1 patient has stress ulcer(2.2%), 2 patients have mild pulmonary infection(4.3%).After treating, 40 patients are improved(87.0%), 5 patients are stable(10.8%), 1 patient discharge automatically, none of them is worsen. In 46 cases, none of them dies of the thalamus infarction directly.ConclusionDifferent arterial supply of the thalamus infarction can appear different clinical manifestations. thalamotubercle artery occlusion is mainly characterized by cognitive and behavior disorders, paramedian artery occlusion mainly characterized by conscious disturbance, at the same time may be accompanied by a vertical gaze palsy, and bilateral thalamus infarction can appear serious conscious disturbance, cognitive dysfunction and vertical gaze palsy. thalamogenilulate artery occlusion is the most common type of thalamus infarction, its main performance are pure sensory stroke, sensory motor stroke and classic Dejerine-Roussy syndrome. posterior choroidal artery occlusion is the most unusual subtype in the thalamus infarction, its main performance are the visual, auditory and disturbance of superficialsensitivity. In terms of etiology, thalamus infarction is the most common for small vessel disease. The risk factors of thalamus infarction are diabetes, hypertension, smoking and so on. At the same time, the thalamus infarction curative effect is better than others.