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The thalamic ataxia syndrome

Department of Medicine, Division of Neurology, University of Texas Health Science Center at San Antonio (Dr. Solomon)
Department of Radiology, University of Texas Health Science Center at San Antonio (Dr. Bazan)
Department of Neurology, University of Texas Southwest Medical Center of Dallas (Dr. Barohn)
Department of Neurology (Dr. Grissom), Wilford Hall US Air Force Medical Center, Lackland AFB, San Antonio, TX.

Article abstract –We identified 10 patients with contralateral ataxia and hemisensory loss following unilateral thalamic lesions. Seven patients had ischemic infarcts, and three had hemorrhages. Hemiparesis, when present, was only a transient finding, whereas ataxia, dysmetria, dysdiadochokinesia, rebound, and hemisensory loss persisted. Two patients had cerebellar outflow tremor. Another developed a severe Déjerine-Roussy pain syndrome. Four patients had lesions of the dominant hemisphere, and two had visual field deficits. None had mutism, aphasia, or astasia. On radiographic evaluation, all patients had lesions in the mid to posterior thalamus, a localization consistent with a lesion of the dentatorubrothalamic and ascending sensory pathways into the thalamus. The thalamic ataxia syndrome has a distinct localizing value that is distinguishable from the ataxic hemiparesis syndrome. Strokes occurring in the ventral lateral and posterior nuclei of the thalamus produce the clinical picture of contralateral "cerebellar" dysfunction and sensory loss with only transient weakness.

Address correspondence and reprint requests to Dr. Diane H. Solomon, Division of Neurology, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7883.

Received July 27, 1993. Accepted for publication in final form October 26, 1993.

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