Thalamic syndrome of Dejerine-Roussy
- Vascular occlusion of the thalamogeniculate branch of posterior cerebral artery which supplies the posterolateral part of thalamus.
- Features
- Anaesthesia dolorosa (painful anaesthesia)
- Pansensory loss contralateral to the side of lesion
- Due to involvement of ventral posterior nuclei)
- Thalamic pain
- Severe, persistent, paroxysmal and intolerable pain
- due to involvement of intralaminar and other non-specific nuclei
- Transient hemiparesis
- Due to involvement of internal capsule
- Hemiataxia and choreiform movements
- Due to involvement of pallidofugal fibres which intersect internal capsule and subthalamus
- Homonymous hemianopia
- Due to involvement of lateral geniculate body
Type | Group | Nucleus | Specific Inputs | Output | Function | Deficits |
Relay | Motor relay | Ventral anterior (VA) | Globus pallidus, SN, cerebellum | Premotor (area 6) and PFC | Planning of movement (cortico-subcortico-cortical loop) | ㅤ |
ㅤ | Motor relay | Ventral lateral (VL) | Cerebellum, GP, SN | Primary motor (area 4) and premotor (area 6) | Initiation of movement (cortico-cerebello-cortical loop) | Ataxia, mild motor weakness, language, memory difficulties |
ㅤ | Sensory modulator group | Lateral dorsal (LD) | Hippocampus (fornix) | Cingulate gyrus | Limbic (memory) | Impaired visual discrimination, hemispatial neglect, language deficits, psychosis |
ㅤ | ㅤ | Ventral intermediate (VIM) | Cerebellum | Primary motor cortex (area 4) | Coordination of movement | ㅤ |
ㅤ | Sensory relay | Ventral posterolateral (VPL) | Medial lemniscus (body), spinothalamic tract (body) | Somatosensory cortex (area 1-3) | Somatosensory (body) | Dejerine-Roussy disease (thalamic pain syndrome); contralateral hemianesthesia (typically for all sensory modalities) of body and limbs (VPl) or head and neck (VPm) |
ㅤ | Sensory relay | Ventral posteromedial (VPM) | Medial lemniscus (face), spinothalamic tract (face), Central tegmental tract (taste) | Somatosensory cortex (area 1-3), Insula | Somatosensory (head and taste) | Dejerine-Roussy disease (thalamic pain syndrome); contralateral hemianesthesia (typically for all sensory modalities) of body and limbs (VPl) or head and neck (VPm) |
ㅤ | Sensory relay | Medial geniculate (MGN) | Brachium of the inferior colliculus | Auditory cortex (area 41,42) | Auditory relay | Central deafness |
ㅤ | Sensory relay | Lateral geniculate (LGN) | Optic tract | Visual cortex (Area 17) | Visual relay | Contralateral homonymous hemianopia (loss of vision in the same visual field on both eyes) |
ㅤ | Limbic group | Anterior | Mammillothalamic tract, hippocampus | Cingulate gyrus | Limbic (emotion and memory) | Amnesia, language difficulties (reduced spontaneous speech, anomia) |
Association | Limbic group | Dorsomedial (DM) | Prefrontal cortex, olfactory and limbic structures | Prefrontal cortex | Limbic (Emotional response to pain and memory) | Apathy, abulia, disinhibition, working memory deficits, sleep dysregulation |
ㅤ | Sensory modulator group | Lateral posterior (LP) | Unknown | Parietal association cortex | Unknown | Impaired visual discrimination, hemispatial neglect, language deficits, psychosis |
ㅤ | Sensory modulator group | Pulvinar | Parietal, occipital, and temporal lobes | Parietal-occipital-temporal association cortex | Visual association | Impaired visual discrimination, hemispatial neglect, language deficits, psychosis |
Regulatory | Nonspecific thalamic group | Reticular | Thalamus and cortex | All thalamic nuclei | Attention | Apathy, abulia, disinhibition, working memory deficits, sleep dysregulation |
ㅤ | Nonspecific thalamic group | Centromedian (CM) | Brainstem | Putamen and motor cortex | Attention and arousal | Apathy, abulia, disinhibition, working memory deficits, sleep dysregulation |
ㅤ | Nonspecific thalamic group | Parafascicular | Brainstem | Caudate nucleus and PFC | Attention and arousal | Apathy, abulia, disinhibition, working memory deficits, sleep dysregulation |
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