Factors Affecting The Etiology of Isolated Thalamic Infarcts And Thalamic Infarcts With Extrathalamic Involvement: The Stroke Center Experience

Abstract

Objective: The thalamus is a control point that is a gateway for all sensory impulses except smell and contributes to regulating the sleep-wake process. Therefore, infarcts of the thalamus cause a diversity of symptoms along with a diversity of vascular anatomy. The fact that thalamic infarcts are mostly considered lacunar infarcts seems to create inadequacy in understanding the etiology. This study aimed to compare the etiologic, diagnostic, and therapeutic parameters of thalamic infarction. Materials and Methods: This retrospective study analyzed 230 patients with thalamic infarction among 820 stroke patients admitted between January 2019 and April 2022. Patients with hemorrhagic stroke, malignancy, or infection were excluded. Demographic data, comorbidities, imaging results, and treatments administered were evaluated. All these results were analyzed in two subgroups: isolated thalamic and extrathalamic involvement. Results: Bilateral thalamic involvement was 8.386 times more common in patients with extrathalamic participation. Patients using dual antiaggregants had 2.207 times higher isolated thalamic involvement, while those on oral anticoagulants had 2.378 times higher extrathalamic involvement. Pathologies in the basilar and vertebral arteries increased the risk of extrathalamic involvement by 2.660 times (p<0.001). Conclusion: Thalamic infarcts cannot be considered exclusively lacunar. Extrathalamic involvement has been associated with worse functional scores and arterial pathologies. The protective effects of dual antiaggregants and oral anticoagulants vary depending on whether the thalamic infarct is extrathalamic or not, emphasizing the need for individualized therapies.

Keywords

• Thalamus; Stroke
• Extrathalamic involvement
• Antiaggregant

Ethical Statement

S.B.Ü. Antalya Training and Research Hospital Clinical Research Ethics Committee decision dated 23/05/2024 and numbered 7/11 was taken with the application numbered 2024-152.

İzole Talamik Enfarkt ile Ekstratalamik Tutlumun Eşlik Ettiği Talamik Enfarktların Etiyolojisine Etki Eden Faktörler: İnme Merkezi Deneyimi

Abstract

Giriş: Talamus, koku hariç tüm duyular için bir geçit, uyku-uyanıklık sürecinin düzenleyicisi ve duyusal ve motor giriş ve çıkışlar için kontrol noktasıdır. Vasküler anatominin çeşitliliği talamik enfarktların semptomlarını da etkilemektedir. Çoğunlukla laküner sendrom olarak tanı konulması, etiyolojinin anlaşılmasını daraltıyor gibi görünmektedir. Bu çalışmanın amacı, hastaların tanı ve tedavi parametrelerini karşılaştırmaktır. Gereç ve Yöntemler: Bu retrospektif çalışmada, Ocak 2019 ile Nisan 2022 tarihleri arasında başvuran 820 inme hastası arasından talamik enfarktüs geçiren 230 hasta analiz edildi. Hemorajik inme, malignite veya enfeksiyonu olan hastalar çalışma dışı bırakıldı. Demografik veriler, komorbiditeler, görüntüleme sonuçları, tedaviler ve kabul ve taburculuk sırasındaki Modifiye Rankin Skalası (mRS) skorlarına ilişkin veriler toplanmıştır. İstatistiksel analizler SPSS V23 kullanılarak izole ve ekstratalamik tutulumu karşılaştırdı. Bulgular: Bilateral talamik tutulum ekstratalamik tutulumu olan hastalarda 8.386 kat daha sıktı. mRS skorları hem başvuru (p=0.009) hem de taburculuk (p=0.003) sırasında ekstratalamik tutulumu olan hastalarda anlamlı olarak daha yüksekti. İkili antiagregan kullanan hastalarda izole talamik tutulum 2,207 kat daha fazlayken, oral antikoagülan kullananlarda ekstratalamik tutulum 2,378 kat daha fazlaydı. Baziler ve vertebral arterlerdeki patolojiler ekstratalamik tutulum riskini 2.660 kat artırmıştır (p<0.001). Tartışma: Talamik infarktlar sadece laküner etiyolojiye bağlanamaz. Ekstratalamik tutulum daha kötü sonuçlar ve arteriyel patolojilerle ilişkilendirilmiştir. İkili antiagreganların ve oral antikoagülanların koruyucu etkileri infarkt tipine göre değişmekte olup, kişiye özel tedavilere olan ihtiyacı vurgulamaktadır.

Keywords

• Talamus
• İnme
• Ekstratalamik tutulum

Ethical Statement

S.B.Ü. Antalya Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu 2024-152 Sayılı başvuru ile 23/05/2024 tarih ve 7/11 nolu karar alınmıştır.

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