A 52-year-old man was noted to display “unusual behavior” with transient agitation and blurry vision after otherwise uneventful diagnostic cardiac catheterization. Several hours after same-day discharge from the hospital, he suddenly became comatose, requiring intubation and admission to the intensive care unit. Two days later, he regained consciousness and was noted to have vertical gaze palsy and dysarthria without other neurologic deficits. Magnetic resonance imaging demonstrated bilateral acute medial thalamic ischemic strokes (Figure). Magnetic resonance angiography did not display extracranial or intracranial arterial stenosis (not shown). At 3 months' follow-up, he had only mild residual dysarthria.
Magnetic resonance image of the brain indicating bilateral thalamic infarction. A, Fluid attenuated inversion recovery imaging showing high signal intensity in bilateral medial thalami (arrows). Axial diffusion-weighted image (B) and corresponding (C) apparent diffusion coefficient (ADC) map obtained 24 hours after symptom onset showing respective restricted diffusion and reduced ADC values (arrows), indicating acute bilateral paramedian thalamic infarction.
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