1514 - An Atypical Sensory Loss Pattern in an Isolated Thalamic Stroke - A Case Report

Case Diagnosis: Right thalamic ischemic stroke

Case Description: 51-year-old male presented to the emergency department with left-sided hemiparesthesia and left leg discoordination. The initial brain CT scan was negative, and the follow-up brain CT three days after the onset of symptoms was also negative. Thalamic strokes typically present with contralateral hemiparesis and hemisensory loss, unreactive pupils, and gaze palsy with gaze deviation away from the side of the infarct. This patient presented atypically with pure hemiparesthesia without facial involvement. Following two negative CT scans, an MRI finally revealed the cause of this patient's symptoms - an ischemic incident in the right thalamus. During admission, the patient was put on aspirin 324 mg and clopidogrel 300 mg. Over his 3-day hospital course, the patient’s left-sided paresthesias improved and he was stable for discharge.

Discussions: This patient presented atypically with persistent neurologic symptoms after several days, highlighting the challenges and intricacies of diagnosing subtle cerebrovascular events. This case highlights the importance of using MRI imaging in a patient with persistent symptoms of stroke, despite having two negative CTs and maintaining high levels of suspicion after negative initial tests. Rapid identification and treatment of a stroke can significantly reduce brain damage and improve outcomes.

Conclusions: CVAs and other ischemic events of the brain may present in atypical ways that require detailed evaluation. Through this case, we are shown the demand for more advanced imaging studies, such as MRI, when symptoms of a cerebrovascular accident are persistent following a negative CT. The novelty of a patient presenting with pure hemiparesthesia, without facial involvement or other focal neurological deficits, demonstrates how neurological cases may present in uncommon ways. Our findings bring attention to the importance of timely clinical decision-making to ensure that correct treatment is delivered, avoiding further brain damage and improving patient outcomes in cases of atypical isolated thalamic strokes.