Acute right-sided thalamic stroke successfully treated with thrombolytics

In the United States, an acute stroke occurs every 40 seconds, with stroke accounting for one in six deaths in 2021.Worldwide, strokes are the third leading cause of disability and the second leading cause of death [1,2].Lacunar infarcts are one of the most common subtypes of ischemic stroke and may symbolize future risks of progressive disease in small perforating arteries, venules of the brain, and capillaries, categorized as small-vessel disease [3].These types of strokes are small, 15 mm in diameter, and primarily occur in noncortical regions [4].However, lacunar strokes can differ by the size of the underlying brain infarct: small lacunar strokes commonly result from hypertensive small-artery disease, while larger ones originate from atheroma or an occlusion [5].Twenty-five percent of ischemic strokes are categorized as lacunar [6].This condition also contributes to 40% of dementia cases [7].Considering demographics, men are at a greater risk of cognitive impairment from acute lacunar stroke [8].These findings demonstrate that severe motor complications are common contributors to life-long disabilities in stroke patients.Although lacunar strokes occur in small vessels, thrombolysis has been shown to confer a significant reduction in stroke severity (as measured by post-tissue plasminogen activator [post-tPA] US National Institutes of Health Stroke Scale [NIHSS]) as well as functional outcomes (as measured by the modified Rankin score).A secondary analysis of the WAKE-UP trial included 108 patients with lacunar stroke, of which 51% received alteplase [9].Fifty-nine percent in this group had a favorable outcome compared to those receiving the placebo.Similarly, a secondary analysis of the Alteplase Compared with Tenecteplase trial found that patients with lacunar infarcts did better after thrombolysis, including fewer (zero) cases of intracranial hemorrhage [10].The patient described in this study suffered a right-sided thalamic stroke.The thalamus is part of the limbic system and is comprised of different subgroups of nuclei that serve unique roles, from relaying sensory and motor skills to regulating alertness and consciousness [11].Thalamic strokes can manifest in many forms depending on which artery is compromised [12].The posterior choroidal artery supplies the posterior portion of the thalamus, including the lateral and geniculate bodies, and damage to this area can impact visual processing.Separately, the paramedian artery supplies the medial aspects of the thalamus, where damage can result in memory issues and sleep disturbances [13].Meanwhile, the tuberothalamic artery supplies the anterior and anterolateral parts of the thalamus, and infarcts in these areas can lead to impairments in arousal, orientation, memory, and personality.However, perhaps the most vulnerable territory is the inferolateral area; here, the inferolateral thalamic artery supplies the lateral aspects of the thalamus, and damage to it can cause contralateral sensory loss, hemiparesis, and pain syn-1