Case Presentation: A 62-year-old right-handed female with a past medical history significant for hypertension, hyperlipidemia, and diabetes mellitus presented to the emergency department with a one week history of perioral numbness, gait imbalance and increased somnolence. She reported being lethargic and sleepy most of the day. Neurological exam was normal except for mild left sided pronator drift, ataxic gait and executive dysfunction of the left hand. Magnetic resonance imaging (MRI) of the brain revealed a 1.9 cm sub-acute infarct that included paramedian nuclei of right thalamus. Work up was negative for cardiac embolic source, significant carotid stenosis and atrial arrhythmia. Her symptoms were attributed to the thalamic stroke. Her ataxia gradually improved over the next five days, however hypersomnia persisted.
Discussion: Paramedian thalamic stroke commonly presents with hypersomnolence, oculomotor palsy, mild gait ataxia, deficits of attention, memory impairment and behavior changes. Hypersomnolence has been thought to be caused by a disruption ofthalamic sleep generation and arousal mechanisms. Hence, thalamic stroke must be considered in the differential of sleep and concentration disturbances especially if associated with other neurological findings such as ataxia and executive dysfunction.
Conclusions: Thalamic stroke can present with a myriad of symptoms including thalamic pain syndrome and sensory abnormalities to less commonly encountered deficits of attention and hypersomnolence. The latter symptoms are uncommon symptoms of stroke unless accompanied by large infarcts causing herniation or affecting the reticular activating system (RAS). We report a case of thalamic stroke presenting with increased somnolence and executive dysfunction.
To cite this abstract:Ghimire S, Karmacharya P, Poudel D, Pathak R, Lloyd B, Khanal R. Wake Me Up: Thalamic Stroke with Hypersomnolence. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. Abstract 527. Journal of Hospital Medicine. 2015; 10 (suppl 2). https://www.shmabstracts.com/abstract/wake-me-up-thalamic-stroke-with-hypersomnolence/. Accessed April 6, 2020.