• Alex Förster, Ingo Nölte, Holger Wenz, Mansour Al-Zghloul, Hans U Kerl, Marc A Brockmann, and Christoph Groden.
• Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
• J Neuroimaging. 2014 Jul 1;24(4):325-30.

Background And PurposeBilateral paramedian thalamic infarction is a rare subtype of stroke the etiology of which still remains undetermined in many patients.MethodsFrom a computed tomography (CT)/magnetic resonance imaging report database, we identified and analyzed 48 patients with bilateral paramedian thalamic infarction on diffusion-weighted imaging. Vascular pathologies were noted on CT angiography (CTA)/magnetic resonance angiography (MRA) and the P1 segments of the posterior cerebral artery (PCA) described as normal, hypoplastic, or absent.ResultsVascular imaging revealed top of the basilar artery (BA) occlusion in 6 (12.5%), BA occlusion in 4 (8.3%), BA stenosis in 1 (2.1%), and BA hypoplasia in 3 (6.3%), PCA occlusion in 4 (8.3%), and PCA stenosis in 4 (8.3%) patients. In 18 (37.5%) patients, one or both P1 segments of the PCA were hypoplastic or absent. Patients with hypoplastic/absent P1 segments were more likely to have exclusively bilateral paramedian thalamic lesions (P < .001). An embolic source could be identified in 25 (55.6%) patients; there were no significant differences between both groups.ConclusionsVascular imaging is useful to determine underlying vascular pathologies and may support the diagnosis of small vessel disease in those patients with isolated bilateral paramedian thalamic infarction, hypoplastic/absent P1 segment of the PCA, and lack of vascular pathology.Copyright © 2013 by the American Society of Neuroimaging.

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