Unilateral thalamic infarction onset with lethargy: A case report and literature review

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Introduction:

Infarct-induced lethargy is a common disabling symptom that lacks a consensual definition and a standardized method of care. Identifying the causes of the infarct in the thalamic reticular nucleus (TRN) induced lethargy is crucial in stroke patients.

Case presentation:

A 68-year-old female patient was admitted to the hospital with lethargy and weakness in the right limb. A computed tomography (CT) scan performed at the presentation showed no bleeding. She was given intravenous thrombolysis. A head computed tomography (CT) scan clearly showed that the infarct was located in the TRN. After 1 hour of treatment, the weakness in the patient’s limb was relieved. However, she was still lethargic, but her lethargy symptoms improved after 3 days.

Discussion and conclusions:

Our case highlights that despite the small size of the infarct, the patient was unconscious, which makes it difficult for physicians to understand and treat the condition, resulting in trouble managing the case. We performed a literature review and proposed that the infarction located in the TRN causes lethargy. However, further clinical and pathophysiological research is still needed to improve patient care.

Related collections

Most cited references 31

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Until recently, the electrophysiological mechanisms involved in strengthening new memories into a more permanent form during sleep have been largely unknown. The sleep spindle is an event in the electroencephalogram (EEG) characterizing Stage 2 sleep. Sleep spindles may reflect, at the electrophysiological level, an ideal mechanism for inducing long-term synaptic changes in the neocortex. Recent evidence suggests the spindle is highly correlated with tests of intellectual ability (e.g.; IQ tests) and may serve as a physiological index of intelligence. Further, spindles increase in number and duration in sleep following new learning and are correlated with performance improvements. Spindle density and sigma (14-16Hz) spectral power have been found to be positively correlated with performance following a daytime nap, and animal studies suggest the spindle is involved in a hippocampal-neocortical dialogue necessary for memory consolidation. The findings reviewed here collectively provide a compelling body of evidence that the function of the sleep spindle is related to intellectual ability and memory consolidation. Copyright © 2010 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Wei Kong

Lei Ma

Changyou Yin

Wei Zhao

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MD

Title: Medicine

Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: 02 December 2022

Publication date (Electronic): 02 December 2022

Volume: 101

Issue: 48

Electronic Location Identifier: e32158

Affiliations

[a ] Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China

[b ] Department of Anaesthesiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.

Author notes

* Correspondence: Yanbin Wang, Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 Yuhuangding East Road, Yantai 264000, China (e-mail: jietong-5@ 123456163.com ).

Author information

Yanbin Wang https://orcid.org/0000-0002-9519-3014

Article

Accession ID: 00081

DOI: 10.1097/MD.0000000000032158

PMC ID: 9726381

PubMed ID: 36482596

SO-VID: 4ca1085a-bb08-43a2-bbc3-92434eabbf43

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 28 October 2022

Date received : 11 November 2022

Date accepted : 14 November 2022

Custom metadata

OPEN-ACCESS TRUE

Keywords: case report,cerebral infarction,lethargy,reticular nucleus of thalamus,review

Data availability:

Keywords: case report, cerebral infarction, lethargy, reticular nucleus of thalamus, review