When Both Thalami Speak: A Diagnostic Journey Through Vascular, Metabolic, and Neoplastic Pathologies

Abstract

Background: Bilateral thalamic lesions are uncommon yet clinically significant radiologic findings. Their etiology spans vascular, metabolic, toxic, neoplastic, and genetic domains, often manifesting as altered sensorium, seizures, or cognitive deficits. A structured approach using clinical correlation and advanced imaging is essential to diagnose and manage these conditions.
Objective: This review aims to provide a practical diagnostic framework for bilateral thalamic lesions by correlating common etiologies with imaging findings and highlighting treatable conditions.
Conclusion: Recognizing specific patterns on MRI, particularly diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), and susceptibility-weighted imaging (SWI), enables early diagnosis and intervention. Integration of neuroimaging with clinical context is key to differentiating reversible from progressive pathologies.
Keywords: bilateral thalamic lesions, MRI, artery of Percheron, Wernicke's encephalopathy, CVST, lymphoma, PRES, glioma