Understanding Thalamic Stroke: Effects, Treatment, and Recovery

A stroke in the thalamus can have unique effects for every survivor. To understand how a thalamic stroke affects the body, it helps to look at what a stroke is and what functions the thalamus controls. This article will explain just that, along with an overview of the recovery process.

Use the links below to jump straight to any section:

• Causes
• Effects
• Recovery Process
• Recovery Time

Understanding a Stroke in the Thalamus

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

When a stroke affects the thalamus, it is because an artery in this area deep within the brain has been affected. Thalamic strokes fall under the category of subcortical strokes or lacunar strokes, which affect the deeper brain regions beneath the cerebral cortex, as opposed to the outer cortical region.

When a stroke occurs, it is a medical emergency as brain cells begin to die within minutes of losing blood supply. Blood flow needs to be restored as soon as possible to save the person’s life.

Survivors of stroke that receive swift, fast treatment usually experience fewer secondary effects and functional impairments than those who receive delayed treatment.

After a stroke has been medically treated, rehabilitation should begin as soon as possible to address any resulting secondary effects.

Secondary Effects of a Thalamic Stroke

Each area of the brain controls different functions. Depending on where a stroke occurs, it can impair a variety of different bodily functions. For thalamic stroke survivors, we can look at the role of the thalamus for insight into the secondary effects that may occur.

The thalamus plays a role in our memory, emotions, sleep-wake cycle, executive functions, processing sensory input, and sensorimotor control. When a stroke affects the thalamus, it can impair some of these functions — especially the processing and transmission of sensory information.

The thalamus is responsible for relaying 98% of all sensory input within the body. Therefore, issues with sensation after a thalamic stroke are common.

Potential secondary effects of a thalamic stroke include:

• Impaired sensation. Numbness or tingling sensations are common after a thalamic stroke.
• Sleep disturbances. Individuals may struggle with insomnia after a stroke in the thalamus.
• Amnesia. A thalamic stroke may result in memory loss (vascular thalamic amnesia) that can affect long- or short-term memory. It can also be accompanied by a shift in personality.
• Changes in attention. Attention, along with memory, is a high-level cognitive skill that the thalamus plays a role in. Thus, a stroke in the thalamus can affect an individual’s ability to pay attention.
• Speech difficulties. Language and communication difficulties such as aphasia may occur after a thalamic stroke.
• Hemispatial neglect. This causes the individual to be unaware of the environment on the affected side of their body, opposite of the side of the brain that was damaged. It usually occurs when the right hemisphere of the brain is affected (in this case, the right portion of the thalamus) which causes neglect of the opposite side of the body (left neglect).
• Vision impairments. There are many types of vision impairments that can occur after a thalamic stroke, such as diplopia (double vision) or hemianopia where half the visual field is missing.
• Difficulties with balance. The brain stem, which is near the thalamus, helps regulate vertical eye position and head posture. When these functions are affected by a stroke, it can result in poor balance, which can also result in poor gait.
• Central post-stroke pain. This involves chronic neuropathic pain, also known as thalamic pain when following a thalamic stroke.

Thalamic pain is a chronic condition that can have delayed onset. Sometimes it can take months or even years after a thalamic stroke for pain to develop. It is a relatively common complication, affecting up to 8% of individuals following a stroke.

It may start off as impaired sensation and later progress into thermal dysregulation such as freezing or scalding sensations. Over time, it can continue to progress to severe, chronic pain.

This makes it essential to communicate with your medical team if you are concerned about changes in your health and well-being after a stroke.

The Recovery Process After a Thalamic Stroke

Recovery from thalamic stroke revolves around restoring and compensating for the abilities that were compromised by the stroke.

Not all secondary effects can be partially or fully resolved, but the intensity and timeliness of rehabilitation has a meaningful impact on how much function a person can recover.

Pursuing intensive rehabilitation early on and making an effort to integrate skills learned during rehabilitation into your daily life optimizes recovery outcomes.

Here are some steps that survivors may take during the stroke recovery process:

1. Physical Therapy

When a thalamic stroke leads to motor impairments, physical therapy can help restore movement in the body. It may help with improving posture, gait training, and strengthening as well. If needed, physical therapists are also able to recommend and train individuals how to use the appropriate type of walker or cane to move around safely.

2. Occupational Therapy

Occupational therapy also helps survivors regain mobility, particularly related to the activities of daily living such as eating and dressing. Occupational therapists can also educate individuals on adaptive equipment and compensation techniques to help minimize difficulties with daily tasks, such as using a grab bar or shower chair for those with poor balance.

The benefits of therapy occur through repetitive experience and practice. The brain attempts to become efficient by creating and strengthening neural pathways for tasks that are frequently experienced — a phenomenon is known as neuroplasticity.

3. Home therapy

It’s likely that insurance will cover some PT and OT after stroke. They may even pay for a therapist to come to your home for a short time. However, once insurance stops covering visits with your therapist, it’s critical to keep exercising at home to maintain and further your progress toward recovery.

One way to keep up your motivation for home therapy is by investing in neurorehabilitation devices that are motivating to use. For example, Flint Rehab’s FitMi home therapy helps turn classic rehab exercises into a gamified, interactive experience. As a result, it helps you achieve the high repetition necessary to rewire the brain and improve movement after stroke.

4. Sensory Reeducation

After a thalamic stroke, it’s common for survivors to experience sensory issues such as numbness, tingling, pins-and-needles sensations, or pain.

Sometimes the brain can adapt and regain the ability to process sensory information through a therapy called sensory retraining. Often introduced by an occupational therapist, sensory retraining involves practicing various exercises that involve sensation to encourage the brain to adapt and improve its ability to interpret sensation.

For example, you can alternate placing hot and cold towels on your arm to stimulate the brain’s sensory processing. Be sure to have a caregiver check that the towel isn’t too hot before placing it on your affected arm.

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

5. Vision Therapy

When vision impairments occur after thalamic stroke, stroke survivors can participate in vision rehabilitation therapy. Vision therapy often involves various eye exercises to retrain the brain how to control the eye muscles. Not all patients respond to this therapy, but some are able to achieve partial or full vision recovery.

Vision therapy may also involve learning different techniques to compensate for visual field deficits or inattention, such as the lighthouse strategy, which focuses on visually scanning side to side like a lighthouse light to see an entire area.

6. Speech and Cognitive Therapy

Some potential secondary effects of a thalamic stroke include speech difficulties and changes in executive function such as working memory loss or changes in attention span. A Speech-Language Pathologist is the best expert to seek help from.

An SLP knows how to identify and treat speech and cognitive issues in people with neurological injuries like stroke. It often works best to start therapy with an SLP and continue therapy primarily at home with the guidance of your therapist.

Two SLPs actually created an app that individuals can use at home called the CT Speech & Cognitive Therapy App. Your SLP can assign exercises for you to practice at home, or the app can provide an assessment and recommend exercises based on your ability level.

7. Pain Management

If you struggle with central post-stroke pain, then seeking treatment is critical. Some stroke survivors may find relief through medication or alternative medicine. When nonsurgical pain treatment options fail to provide relief, talk to your doctor about surgical options such as a permanent spinal cord stimulator implant.

It’s crucial to both seek social support and medical treatment for your overall wellness and to minimize depression and other potential psychological effects of living with chronic pain.

Recovery Time After Thalamic Stroke

Recovery time after stroke varies from person to person. This is because every stroke is different and every recovery will be different.

While it’s impossible to predict recovery time for any single person, it’s worth mentioning again that the intensity of rehabilitation has a significant impact on recovery.

When stroke survivors stick with a consistent rehabilitation program after discharge from inpatient therapy, they see better results than individuals that stop pursuing rehab. This is why a motivating home therapy program is often essential for recovery.

Whether it has been months or years since experiencing a stroke, rehabilitation is worth pursuing. When you put in the work, the brain will respond.

Recovering from a Stroke in the Thalamus

Recovery from a thalamic stroke will involve hard work and dedication from the survivor.

During the early stages of stroke recovery, your medical team will assess your condition and any secondary effects that were sustained, such as changes in sensation or balance. Then, you will work with a team of therapists to address these issues.

Your results will partially depend upon the consistency of your rehabilitation program. Find something that motivates you and try your best to stick with it.