A bilateral thalamic ischemic stroke is a rare clinical manifestation resulting mainly from cardioembolism or small vessel disease. The ischemic stroke affecting the thalamus bilaterally may lead to memory and executive dysfunction, dis o rientation, oculomotor and conjugated gaze disturbances, motor deficit, cerebellar symptoms, apathy, stupor, somnolence and a coma. There have only been a few descriptions of the neuropsychological condition prevalent in this group of patients. The aim of the study was to present a detailed neuropsychological manifestation and follow-up with systematic rehabilitation. We present a 57-year-old female patient suffering from a bilateral thalamic ischemic stroke due to cardiogenic embolism of the artery of Percheron. The presented case summarizes the dynamics of the changes in cognitive and executive functions in the patient over the course of six months from the onset. We conclude that all bilateral stroke patients should undergo a detailed neuropsychological assess ment, an early, intensive rehabilitation process and a full cardiac investigation to unearth the potential causes.
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In the motor system, transcranial magnetic stimulation (TMS) has proved an invaluable tool to study the organisation and interaction of the cortical motor areas. In this review I describe some of the ways in which TMS has been used to map out the major topographical features of the motor output and to test how these change in response motor learning or after peripheral (e.g. amputation) or central (e.g. stroke) injury. More recent work has shown that longer periods of repeated TMS involving several hundred to a thousand pulses can lead to lasting changes in motor cortex excitability that are thought to involve changes in the efficacy of intracortical synapses equivalent to LTP and LTP in slice preparations. These are accompanied by changes in the rate of motor learning and are presently being trialled as potential treatments to speed recovery from stroke.
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