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A CASE REPORT OF THE INFARCTlON OF THE BILATERAL THALAMUS AND THE MIDBRAIN Hiroaki Tomimoto 1 , Katsuhiko Ogawa 1 , Minoru Matsuda 1 , Katsumasa Shimada 2 1Department of Internal Medicine, Kurashiki Central Hospital 2Department of Pathology, Kurashiki Central Hospital pp.553-557
Published Date 1984/6/1
DOI https://doi.org/10.11477/mf.1406205330
  • Abstract
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A 63 years old man was admitted because of coma of 24 hours duration. He had a history of infarction of the medulla oblongata 7 months earlier. On admission he was unconscious and had right oculomotor nerve palsy. To a painful stim-ulus, he responded with only a slight body move-ment. On the CT scan, low density areas were seen in the bilateral thalamus and the midbrain. In the next day he recovered from coma and abnormal behaviors appeared such as wondering in the ward, touching other patient's face and manipulating his stool. Verbal expression was extremely poor. Chlorpromazine was needed to supress abnormal behaviors. Thereafter, abnormal behaviors gradually subsided and by the 23 hospital day he became bedridden even when chlorpromazine was withdrawn. At that time, he said only "yes" or "no" in response to questions and only few spontaneous movements were obser-ved. From the 40 hospital day he suffered from pneumonia and gradually sank into the state of akinetic mutism. He died on the 50 hospital day.

Pathologically, infarctions destroyed the n. parafascicularis, n. centromedianus and the intra-laminar nuclei in the left thalamus, n. parafa-scicularis and a part of n. centromedianus in the right. In the medulla oblongata, right n. ambiguus and reticular formation were destroyed. Both thalamic lesions extended posteriorly to unite with the midbrain lesion.

It was considered that the bilateral thalamic infarctions corresponded to the demential beha-viors in the early phase of the clinical course and gradual posterior extention of the lesion toward the midbrain corresponded to the transition to the state of akinetic mutism.


Copyright © 1984, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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