Abstract
The aim of this pictorial review is to familiarize radiologists with the numerous pathologies that can affect bilateral thalami while demonstrating their several neuroimaging manifestations. Vascular etiologies include infarcts of the artery of Percheron, tip of the basilar syndrome, venous infarcts, hypoxic-ischemic encephalopathy, PRES, hypertensive microbleeds, and CADASIL; infectious etiologies include Creutzfeldt-Jakobs disease and encephalitides, while demyelinating disorders include ADEM and MS. Bilateral thalamic involvement may also be seen in metabolic & toxic etiologies such as Wernicke encephalopathy, osmotic myelinolysis, Fabry disease, Fahr disease, Wilson disease, and Leigh disease. Furthermore, low- and high-grade gliomas may originate or infiltrate bilateral thalami while gadolinium deposition can be a mimicker of disease. Radiological features that can be used in the assessment and differential approach include MR signal characteristics, calcifications, exact location within the thalamus, symmetry, presence of synchronous extra-thalamic involvement, and presence of expansion. Additional imaging tools such as DWI, MRA/MRV/CTA/CTV, MRS, PWI, and correlation with clinical and laboratory findings may narrow the differential diagnosis.
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