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

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.