Talamo

TUPAINCO
Thalamic Blood Supply

•   tuberothalamic, CP
•   paramedian, P1
•   inferolateral, P2
•   posterior choroidal
        ves...
Schematic diagram of lateral (A) and dorsal (B)
 views of the 4 major thalamic arteries and the nuclei
                   ...
•   tuberotalamica       •   Comunicante post
•   paramediana          •   P1
•   inferolateral        •   P2
•   Coroidea...
TuT


PaM     InL


        CoP
TUBEROTALAMICA

     Co-Post
Tuberothalamic Artery
                 Infarction
originates from the middle third of the posterior communicating artery

...
• In the early stages of infarction, patients exhibit fluctuating
  levels of consciousness and appear withdrawn. Persiste...
• considered the amnestic syndrome to represent a
  disconnection between anterior thalamic nuclei
  and hippocampal forma...
PARAMEDIANA

    P1
PARAMEDIAN ARTERY
            P1




C, Percheron’s15 representation of the varying patterns of origin
of the paramedian a...
Variations of the paramedian thalamic-mesencephalic arterial
                     supply according to Percheron.
         ...
Paramedian Artery Infarction
• arise from the P1 section of the posterior
  cerebral artery, to which the term
  "mesencep...
PARAMEDIANA
TALAMOSUBTALAMICA
      neuropsychological disturbances
      predominantly in the areas of
      arousal and ...
• Speech and language
  impairments are characterized
  by hypophonia and
  dysprosody, with frequent
  perseveration, mar...
COMA VIGIL MUTISMO AKINETICO CRONOTARAXIS EYE
 MOVEMENT ABNORMALITIES DEMENCIA TALAMICAasterixis,
complete or partial vert...
often accompanied by eye
movement abnormalities. The
anterograde and retrograde
memory deficit and apathy can be
severe an...
INFEROLATERAL

     P2
Inferolateral Artery Infarction
• 1) The medial branch supplies the external half of the medial
  geniculate nucleus.
• (2...
Inferolateral Artery Infarction
clinical triad of ataxia, mild hemiparesis, and hemisensory loss on the
                  ...
Coroidea Posterior

        P3
Posterior Choroidal Artery
           Infarction
• Alteraciones del campo visual
  cuadrantopsia hemianopsia
• Variable se...
Tuberotalamica
CP




Paramediana
Central de Percheron
P1



 Inferolateral
 P2
TU   Tuberotalamica        CP




     Paramediana
PA                              P1
     Central de Percheron



IN   In...
ZONAS LIMITROFES
   VARIANTES
       Anteromedian territory ( [13%]) involving anterior and
       paramedian territories,...
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Talamo ppt

  1. 1. Talamo TUPAINCO
  2. 2. Thalamic Blood Supply • tuberothalamic, CP • paramedian, P1 • inferolateral, P2 • posterior choroidal vessels P3
  3. 3. Schematic diagram of lateral (A) and dorsal (B) views of the 4 major thalamic arteries and the nuclei they irrigate 1, carotid artery; 2, basilar artery; 3, P1 region of the posterior cerebral artery (mesencephalic artery); 4, posterior cerebral artery; 5, posterior communicating artery; DM, dorsomedial nucleus; 6, tuberothalamic artery; IL, intralaminar nuclear complex; 7, paramedian artery; P, pulvinar; VP, ventral posterior complex. 8, inferolateral artery; 9, posterior choroidal artery.
  4. 4. • tuberotalamica • Comunicante post • paramediana • P1 • inferolateral • P2 • Coroidea posterior • P3 TU PA IN CO
  5. 5. TuT PaM InL CoP
  6. 6. TUBEROTALAMICA Co-Post
  7. 7. Tuberothalamic Artery Infarction originates from the middle third of the posterior communicating artery A, Extensive tuberothalamic artery territory infarction on the left (right of image), as well as small lesions in the territory of the inferolateral arteries on the right. B and C, Bilateral infarction in a teenager with patent foramen ovale. The infarcted region is in the tuberothalamic artery territory, although this pattern of bilateral stroke is more usually seen after paramedian artery infarcts. This case is likely an example of the paramedian artery irrigating both the paramedian and the tuberothalamic "territories."
  8. 8. • In the early stages of infarction, patients exhibit fluctuating levels of consciousness and appear withdrawn. Persistent personality changes include disorientation in time and place, euphoria, lack of insight, apathy, and lack of spontaneity. Emotional unconcern may be prominent • The major features of tuberothalamic infarction are impairment of recent memory, impairment of new learning, and temporal disorientation. These are more prominent with left-sided lesions, which also involve both verbal and visual memory impairments. Visual memory impairments are seen after right-sided lesions, and these in general result in less pervasive cognitive impairment
  9. 9. • considered the amnestic syndrome to represent a disconnection between anterior thalamic nuclei and hippocampal formation by virtue of the disruption of the mamillothalamic tract and between amygdala and anterior nuclei by damage to the amygdalothalamic projections passing through the internal medullary lamina. • acalculia • afasia
  10. 10. PARAMEDIANA P1
  11. 11. PARAMEDIAN ARTERY P1 C, Percheron’s15 representation of the varying patterns of origin of the paramedian artery off the mesencephalic/P1 artery.
  12. 12. Variations of the paramedian thalamic-mesencephalic arterial supply according to Percheron. AJNR 2003 Nov-Dec;24(10):2005-8 A, In the most common variation, there are many small perforating arteries arising from the P1 segments of the PCA. B, The artery of Percheron is a single perforating blood vessel arising from one P1 segment. C, The third type of variation is that of an arcade of perforating branches arising from an artery bridging the P1 segments of both PCAs.
  13. 13. Paramedian Artery Infarction • arise from the P1 section of the posterior cerebral artery, to which the term "mesencephalic artery“ • The superior ramus that irrigates the thalamus corresponds to the posterior thalamosubthalamic paramedian artery of Percheron
  14. 14. PARAMEDIANA TALAMOSUBTALAMICA neuropsychological disturbances predominantly in the areas of arousal and memory. A left-right asymmetry is evident in language versus visual-spatial deficits. Impairment of arousal with decreased and fluctuating level of consciousness is a conspicuous feature in the early stages, lasting for hours to days. Confusion, agitation, aggression, and apathy may be persistent features.18–20,23
  15. 15. • Speech and language impairments are characterized by hypophonia and dysprosody, with frequent perseveration, markedly reduced verbal fluency, but generally preserved syntactic structure with occasional paraphasic errors and normal repetition: the adynamic aphasia of Guberman and Stuss
  16. 16. COMA VIGIL MUTISMO AKINETICO CRONOTARAXIS EYE MOVEMENT ABNORMALITIES DEMENCIA TALAMICAasterixis, complete or partial vertical gaze paresis, loss of convergence, pseudo-sixth nerve palsies, bilateral internuclear ophthalmoplegia, miosis, and even intolerance to bright light. Bilateral infarction in the paramedian artery territory may result in an acutely ill and severely impaired patient. Disorientation, confusion, hypersomnolence, deep coma, "coma vigil" or akinetic mutism (awake unresponsiveness), and severe memory impairment with perseveration and confabulation are prominent behavioral features,
  17. 17. often accompanied by eye movement abnormalities. The anterograde and retrograde memory deficit and apathy can be severe and persistent. The syndrome may be characterized in the late stages by inappropriate social behaviors, impulsive aggressive outbursts, emotional blunting, loss of initiative, and a reported absence of spontaneous thoughts or mental activities (see Reference 46 for case reports and early literature), conceptualized as loss of psychic self-activation
  18. 18. INFEROLATERAL P2
  19. 19. Inferolateral Artery Infarction • 1) The medial branch supplies the external half of the medial geniculate nucleus. • (2) The principal inferolateral arteries, the "most voluminous, longest, most vertical of the short branches of the posterior cerebral artery,"13 penetrate between the geniculate bodies, ascend in the lateral medullary lamina, and supply the major part of the ventral posterior nuclei (lateral [VPL], medial [VPM], and inferior [VPI]), as well as the ventral and lateral parts of the VL nucleus more rostrally. • (3) The inferolateral pulvinar branches are posteriorly situated among the inferolateral arterial group and supply dorsal and posterolateral regions, including the rostral and lateral parts of the pulvinar and the LD nucleus.
  20. 20. Inferolateral Artery Infarction clinical triad of ataxia, mild hemiparesis, and hemisensory loss on the contralateral side. thalamic syndrome described by Dejerine and Roussy,58 namely, sensory loss to a variable extent, with impaired extremity movement, sometimes with postlesion pain
  21. 21. Coroidea Posterior P3
  22. 22. Posterior Choroidal Artery Infarction • Alteraciones del campo visual cuadrantopsia hemianopsia • Variable sensory loss, weakness, • aphasia, memory impairment, • dystonia, hand tremor
  23. 23. Tuberotalamica CP Paramediana Central de Percheron P1 Inferolateral P2
  24. 24. TU Tuberotalamica CP Paramediana PA P1 Central de Percheron IN Inferolateral P2 P3 CO coroidea posterior
  25. 25. ZONAS LIMITROFES VARIANTES Anteromedian territory ( [13%]) involving anterior and paramedian territories, with predominantly cognitive impairment, including executive dysfunction, anterograde amnesia, and aphasia in left-sided or bilateral lesions. The most frequent stroke mechanism was cardiac embolism Central territory (4 patients [6%]), with lesions on the central part of the thalamus, resulting in a variety of neurological and neuropsychological signs, reflecting the involvement of several adjacent structures. Microangiopathy was the most frequent etiology. Posterolateral territory (8 patients [11%]), involving inferolateral and posterior territories, with hemihypesthesia as the most frequent manifestation, followed by hemiataxia, executive dysfunction, and aphasia in left-sided lesions. Artery-to-artery embolism and microangiopathy were the main stroke mechanisms.
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