A Case of Bilateral Thalamic Infarct Misdiagnosed as Conversion Disorder

Abstract

Introduction: Thalamic infarcts are rarely seen clinical situations. The most important causes are small vessel diseases and lacunar infarctions, arterio-arterial embolisms due to large artery diseases, emboli originating from the heart, and migrainous strokes. Patients might be misdiagnosed because of presenting similar symptoms that are detected in psychiatric disorders; this may lead to a delay in proper treatment. . Case Report: A 73-year-old female patient presented to the emergency service with dizziness, somnolence, and unwillingness to talk and was initially diagnosed with conversion disorder, consulting with the psychiatry unit. In the neurological examination, limited cooperation, bilateral pupillary expansion, and vertical gaze palsy were observed. In brain magnetic resonance imaging (MRI), a lesion flashing in the diffusion sequences with glowing ADC sequences and acute ischemic lesions compatible with bilateral paramedian thalamic vessel territory were detected; antiplatelet and low-molecular-weight heparin therapy was started. During follow-up, short-term and distant long-term memory problems emerged. At the end of the 1-month followup, gaze paresis and sleepiness partially improved. However, the memory problems and slowness of the overall behaviors did not change prominently. Conclusion: In cases with bilateral paramedian thalamic artery obstruction, persistent amnesia; perseveration; deficits in naming, speech intensity, and fluency; attention; slowness of the overall behaviors; somnolence; emotional changes; decreased motivation; and memory problems are common clinical features. Symptoms may completely improve in a minority of patients.