Teaching NeuroImages: Crying thalamus Manifestation of acute ischemic stroke

 So you described a problem, offered no solution. Useless

Teaching NeuroImages: Crying thalamus Manifestation of acute ischemic stroke

Ahmed Z. Obeidat, Joseph P. Broderick

First published February 27, 2017, DOI: https://doi.org/10.1212/WNL.0000000000003664

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A 58-year-old right-handed man with hyperlipidemia presented with 2 brief episodes of explosive crying and confusion. Physical examination was unremarkable. MRI showed patchy acute ischemic stroke within the left anterior thalamus and magnetic resonance angiography showed stenosis of the P2 segment of the left posterior cerebral artery (figure), likely affecting the thalamogeniculate perforator. Pathologic crying has been termed folles larmes prodromiques and has been described in association with various CNS lesions including thalamic.^1,2 Acute pathologic crying remains a rare presentation of stroke and may easily be overlooked. This report serves to remind clinicians of the importance of detailed neurologic assessment under such circumstances.

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Figure Acute thalamic stroke and localized vascular stenosis

Brain MRI shows (A) diffusion-weighted imaging with diffusion restriction consistent with patchy acute ischemic stroke within the anterior thalamus (right brace) and (B) accompanying apparent diffusion coefficient signal reduction (right brace). (C, D) Magnetic resonance angiography head without contrast shows flow signal drop consistent with stenosis of the P2 segment of the left posterior cerebral artery (red arrows).