PMC8169551_01
(A) Magnetic resonance T1-weighted imaging. Images show abnormal low signal bilateral paramedian thalamic lesions (arrows). (B) Magnetic resonance T2-weighted imaging. Images show abnormal hyperintense bilateral paramedian thalamic lesions (arrows). (C) Fluid attenuated inversion recovery echo MRI. Images show abnormal hyperintense bilateral paramedian thalamic lesions (arrows). (D) Diffusion-weighted axial MR showing diffusion restriction of the bilateral paramedian thalamus (arrows).
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A MRI examination was conducted immediately, which suggested bilateral thalamic acute infarction (Figure 1).
The pupils of the patient were not large at the time of admission; the left pupil was 7 mm, and the right pupil was 5 mm. The patient's bilateral pupils were equally large and round when he was discharged from the hospital.
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Neurological examination revealed the left pupil at 7 mm and the right pupil at 5 mm (Figure 2), bilateral pupil reflex to light disappeared, binocular vertical gaze palsy, bilateral Babinski signs were suspicious positive, the NIHSS score was 6 points, and the GCS score was 13 points.
Magnetic resonance angiography demonstrating patent basilar artery and posterior cerebral arteries.
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The electrocardiogram was normal, echocardiography showed no abnormality, magnetic resonance angiography was normal (Figure 3), and digital subtraction angiography was normal.
PMC8169551_02
(A) T1* gradient echo MRI. Images show abnormal low signal bilateral paramedian thalamic lesions (arrows). (B) T2* gradient echo MRI. Images show abnormal hyperintense bilateral paramedian thalamic lesions (arrows). (C) Fluid attenuated inversion recovery echo MRI. Images show abnormal hyperintense bilateral paramedian thalamic lesions (arrows). (D) Diffusion-weighted axial MR showing diffusion restriction of the bilateral paramedian thalamus (arrows).
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MRI examination was conducted immediately, which suggested bilateral thalamic acute infarction (Figure 4).
The basilar artery and bilateral posterior cerebral arteries were clearly seen by MR angiography.
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The electrocardiogram was normal, echocardiography showed no abnormality, magnetic resonance angiography was normal (Figure 5), and digital subtraction angiography was normal.