Can Pure Thalamic Strokes Lead to Severe Impairment of Arousal?
European journal of neurology June 1, 2025 Elina Jaakkola, Olli Likitalo, Katri Niinivirta-Joutsa et al.
Thalamic damage alone is not sufficient to cause severe impairment of arousal such as coma or stupor. Among nine stroke patients with coma or stupor involving the thalamus, five recovered after endovascular therapy and had residual thalamic lesions. The four patients with long-term coma or stupor had thalamic lesions that extended into specific brainstem regions considered part of the reticular formation. None of the five recovered patients or 500 control stroke patients, including 39 with thalamic lesions, had damage in those brainstem regions. These findings demonstrate that severe arousal impairment requires damage extending beyond the thalamus into the brainstem.