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NEUROLOGY 2006;66:E11
© 2006 American Academy of Neurology
Resident and Fellow Page

Unilateral asterixis after thalamic hemorrhage

Kevin J. Klos, MD and Eelco F.M. Wijdicks, MD

From the Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.

Address correspondence and reprint requests to Dr. Eelco F.M. Wijdicks, Mayo Clinic College of Medicine, Division of Critical Care Neurology, Department of Neurology, W8B, 200 First Street SW, Rochester, MN 55905; e-mail: wijde{at}mayo.edu

A 48-year-old woman with uncontrolled hypertension had abrupt onset of headache. On examination she was drowsy and showed right-sided upper limb asterixis (video). CT scan of the head showed hemorrhage centered in the anterior thalamus on the left (figure). Adams and Foley introduced the term asterixis1 (Greek, a-sterixis, and best translated as "no steadiness"). Bilateral asterixis, which is asynchronous and often asymmetrical, occurs in acute renal, hepatic, and pulmonary disease and in other systemic conditions. Unilateral asterixis points to an acute structural lesion, usually in the thalamus. It may be the only easily identifiable clinical sign.2



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  		Figure. CT without contrast shows an acute hemorrhage in the left anterior thalamus with intraventricular extension.

 

Footnotes

Disclosure: The authors report no conflicts of interest.

References

  1. Adams RD, Foley JM. The neurological disorder associated with liver disease. Res Publ Assoc Res Nerv Ment Dis 1953;32:198–237.[Medline]
  2. Kim JS. Asterixis after unilateral stroke: lesion location of 30 patients. Neurology 2001; 56:533–536.[Abstract/Free Full Text]




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