009 A curious constellation of deficits

We present a series of 10 patients (age range 40–83, median 58) with cerebrovascular disease affecting thalamic function. The presenting complaints were highly variable including; Reduced vigilance with word finding problems, slow vertical saccades and ataxia on waking. Headaches and vomiting followed by reduced vigilance and aphasia. Right hemiparesis and aphasia following 2 weeks of headache and drowsiness. Sudden diplopia, eyes rolling back and loss of consciousness. Sudden expressive dysphasia and right hemiparesis. Reduced vigilance was seen in eight cases, four had residual cognitive deficits (all of whom had bilateral disease) and six had no recognised vascular risk factors. In all of these patients, imaging demonstrated ischaemic or haemorrhagic thalamic lesions, of arterial or venous origin. The range and constellation of deficits produced, many of which are not traditionally associated with posterior circulation cerebrovascular disease and which mimic a number of non-vascular neurological conditions, represents a challenge to acute diagnostic services, particularly in relation to the time window for thrombolysis for arterial ischaemia. Thalamic strokes can also prove an exception to the widely held views that stroke is not a cause of loss of consciousness, and that posterior circulation strokes do not cause dysphasia.