The Ultimate Guide to Thalamic Stroke Recovery

The Ultimate Guide to Thalamic Stroke Recovery

Thalamic stroke is a subcortical stroke that may produce unusual symptoms, and thus make diagnosis difficult.

To shed some light on thalamic stroke recovery, this article will explain everything you need to know from treatment to rehabilitation.

Let’s get started.

What Is a Thalamic Stroke?

A stroke occurs when the supply of blood in the brain is compromised. This can happen when an artery becomes clogged by a blood clot (ischemic stroke) or when a blood vessel bursts (hemorrhagic stroke).

ischemic vs hemorrhagic thalamic stroke

When a stroke happens within the thalamus, it’s called a thalamic stroke. This is considered a subcortical stroke because the thalamus resides deep within the brain.

The thalamus controls these major functions, among others:

  • Relaying sensory signals (98% of all sensory input is relayed by the thalamus)
  • Relaying motor signals to the cerebral cortex
  • Regulation of consciousness, sleep, and alertness

The thalamus is located near the basal ganglia, brain stem, and cerebellum. When a stroke occurs in the thalamus, it can affect these areas too.

Causes of Thalamic Stroke

Eighty five percent of strokes are ischemic strokes. They are often caused by preexisting medical conditions like high cholesterol or diabetes that increase the risk of artery blockages.

The leading cause of hemorrhagic stroke is high blood pressure, which increases the chances of an artery in the brain rupturing from the increased pressure.

When a stroke occurs, it deprives the brain cells in the affected area of oxygen-rich blood. These brain cells begin to die, which leads to brain damage.

This is why a stroke is a medical emergency! Blood flow needs to be restored as soon as possible to save brain tissue and minimize disability.

Thalamic Stroke Symptoms

man with facial drooping exhibiting thalamic stroke symptoms

While a stroke is happening, the person may exhibit these stroke symptoms that can be summarized by the acronym F.A.S.T.:

  • F – Facial drooping
  • A – Arm weakness
  • S – Slurred speech
  • T – Time is brain!

But unfortunately, that’s not all. Thalamic stroke is unique because patients may exhibit none of these “classic” stroke warning signs and instead may experience other strange symptoms like vertigo.

This makes diagnosis difficult until doctors order an MRI. However, early MRIs can produce false negatives, so repeat scans may be required to identify the stroke.

Treatment for Thalamic Stroke

The goal of stroke treatment is to restore blood flow in the brain.

Ischemic stroke (the type caused by a blood clot) is usually treated by clot-busting drugs like aspirin or tPA. Hemorrhagic stroke is usually treated through surgery to repair the ruptured blood vessel and reduce intracranial pressure.

Stroke patients that receive swift, fast treatment usually experience less side effects and disability than those who receive slow treatment. This is again is why stroke is a medical emergency.

After treatment, rehabilitation will begin to restore the stroke side effects caused by the damage.

Side Effects of Thalamic Stroke

doctors discussing thalamic stroke syndromes

Some of the most common side effects of a thalamic stroke are:

  • Sensory issues like tingling, numbness, hypersensitivity, or pain
  • Changes in taste
  • Central pain syndrome (chronic pain or burning/freezing sensation)
  • Vision loss or disturbance
  • Motor impairments
  • Memory issues
  • Impacted attention span
  • Potential coma

Two of these side effects are worth digging deeper into.

Sensory Issues

Because the thalamus relays 98% of the body’s sensory input, sensory issues are the most common side effect of thalamic stroke.

In fact, a small study of 25 thalamic stroke patients found that every single person experienced sensory issues. This does not guarantee that all thalamic stroke patients will experience them, but the chances are high.

Central Pain Syndrome

Another possible side effect of thalamic stroke is a condition called central pain syndrome. Unlike localized pain, which only occurs in one area, central pain syndrome occurs from the nervous system.

It can feel like intense ripping sensations on the skin, intense burning or freezing, and hypersensitivity that causes excruciating pain.

Central pain syndrome can take months or even years to manifest after stroke. Seek medical attention if you develop painful sensations like burning, freezing, pain from a slight breeze, etc.

Rehabilitation for Thalamic Stroke

Recovery from thalamic stroke revolves around restoring the abilities that were compromised by the stroke. Some side effects may not be fully recovered, but there is hope.

Here are some steps your medical team may encourage you to take during thalamic stroke recovery:

1. Physical and Occupational Therapy

physiotherapist working with thalamic stroke patient

When thalamic stroke leads to motor impairments, then physical and occupational therapy can help restore some or all of lost mobility.

Physical therapy works by repeating therapeutic movements to rewire the brain through neuroplasticity.

It’s likely that insurance will cover some PT and OT visits after stroke. Once insurance stops covering those visits, it’s critical to keep exercising at home.

One way to keep up your motivation for home therapy is by investing in tools like Flint Rehab’s FitMi. It helps you achieve the repetitions necessary to rewire the brain and improve movement.

2. Cognitive Rehabilitation Exercises

To improve attention, memory, or other cognitive functions, you can practice cognitive rehabilitation exercises.

It’s a good idea to consult with a speech language pathologist who can assess your problem areas and design a plan to meet your needs.

Then, you can take matters into your own hands by doing your own cognitive exercises or using an app like the CT Cognitive Therapy App.

3. Sensory Reeducation Exercises

person with sensory issues after thalamic stroke doing reeducation exercises

Sensory reeducation is a great option for thalamic stroke patients that struggle with numbness, hot/cold sensations, or tingling sensations.

The goal of sensory reeducation exercise is to reteach the brain how to correctly interpret your senses again.

For example, you can alternate placing hot and cold towels on your arm to stimulate the brain’s sensory processing.

The key is to do these exercises regularly to give the brain enough consistent stimulation to spark neuroplasticity.

Learn more about sensory reeducation exercises »

4. Functional Electrical Stimulation

Sensory reeducation usually requires some sensation to start with though. If you have zero sensation, then you can try using functional electrical stimulation (FES).

FES works by sending small electrical pulses to paralyzed or impaired muscles to help rewire the brain and improve movement. It’s commonly added to cycling exercise equipment to make FES cycles.

It’s not cheap to invest in an FES cycle, but some thalamic stroke survivors see improved sensation with FES cycles even if they started with zero sensation. This provides hope for recovery.

Whether you want to improve mobility or sensation, FES may be able to help.

5. Hot and Cold Showers

Similarly, the stimulation from hot/cold showers also may help “wake up” the brain and improve sensation after thalamic stroke.

This trick works for some stroke survivors, but not all. This illustrates that what works for one stroke survivor may not work for you.

It’s important to experiment with different options until you find something that does work for you. Never give up hope.

6. Pain Management

If you struggle with debilitating pain after stroke, you may have central pain syndrome. If this rare pain disorder develops, it usually occurs months or years after stroke.

Treatments vary widely because everyone responds differently. Some people see partial relief from getting a permanent spinal cord simulator implant. Others get partial relief from Lyrica, nerve blockers, or acupuncture.

It’s crucial to both seek social support and experiment with different treatment options. CPS is serious and requires ample support to minimize depression and other psychological backlash.

These are the most common side effects correlated with thalamic stroke. It’s not a complete list, though, since every stroke is different.

It’s essential to work with your medical team to assess your unique side effects and establish a plan for rehabilitation.

Thalamic Stroke Recovery

Overall, thalamic stroke is a subcortical stroke that may produce strange symptoms and side effects.

Most thalamic stroke patients experience difficulty with sensation and/or movement. During rehabilitation, sensory reeducation and physical therapy can help partially or fully restore those side effects.

Because difficulty with sensation is the most common side effect, patients are encouraged to get creative with treatment. Non-traditional treatments like functional electrical stimulation and hot/cold showers may help.

Thalamic stroke survivors should be encouraged to pursue a full recovery because it will lead to better outcomes than settling for partial recovery.

“Shoot for the moon. Even if you miss, you’ll land among the stars.” –Normal Vincent Peale