A thalamic stroke is a rare type of subcortical stroke that may produce unusual symptoms and thus make diagnosis difficult.
To help you understand thalamic stroke recovery, this article will explain everything you need to know from treatment to rehabilitation.
Causes of 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).
Eighty five percent of strokes are ischemic strokes. They are often caused by preexisting medical conditions like high blood pressure, high cholesterol, or diabetes, which 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 happens within the thalamus, it’s called a thalamic stroke. This is considered a subcortical stroke because the thalamus resides deep within the brain.
When a thalamic stroke occurs, it deprives the brain cells in the thalamus 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
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 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 sometimes 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 again is why stroke is a medical emergency.
After treatment, rehabilitation will begin to restore the stroke side effects caused by the damage.
Role of the Thalamus
To understand thalamic stroke recovery, it helps to understand what functions the thalamus controls.
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.
Side Effects of Thalamic Stroke
Understanding what the thalamus controls can help make sense of the side effects that occur after thalamic stroke.
Some of the most common side effects of a thalamic stroke are:
- Sensory issues like tingling, numbness, hypersensitivity, or pain
- Central post-stroke pain (also known as thalamic syndrome or Dejerine-Roussy syndrome)
- Changes in taste
- Vision loss or disturbance
- Motor impairments
- Memory issues
- Impacted attention span
- Potential coma
Two of these side effects are worth digging deeper into.
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 Post-Stroke Pain (Thalamic Syndrome)
Another possible side effect of thalamic stroke is a condition called central post-stroke pain. Unlike localized pain, which only occurs in one area, central post-stroke pain 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 post-stroke pain often has delayed onset and, if it develops, usually takes months or even years to manifest.
If you suspect that you’re developing central post-stroke pain, seek medical attention immediately.
Thalamic Stroke Recovery Process
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
When thalamic stroke leads to motor impairments or tremors after stroke, then physical and occupational therapy can help restore some or all of your lost mobility and function.
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. Sensory 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 is to reteach the brain how to correctly interpret your senses again without “overreacting” to sensations.
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.
3. Functional Electrical Stimulation
Sensory reeducation usually requires some sensation to start with. 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. Your therapists should help you set up the FES machine.
4. Vision Therapy
When vision impairments occur after thalamic stroke, patients can participate in vision rehabilitation therapy. Not all patients respond to this therapy, but some are able to achieve partial or full vision recovery.
Vision therapy often involves eye exercises after stroke to retrain the brain how to control the eye muscles.
5. Central Pain Management
If you struggle with central post-stroke pain, then seeking treatment is critical. Some patients find moderate relief from antiepilepsy and antidepressant drugs like Gabapentin and Anitriptyline, which need to be prescribed by a doctor.
Those that do not respond to medication can seek further treatment like a permanent spinal cord simulator implant.
It’s crucial to both seek social support and experiment with different treatment options. Central post-stroke pain requires ample support to minimize depression and other psychological backlash.
Hope for Thalamic Stroke Recovery
Overall, thalamic stroke is a subcortical stroke that often results in sensory issues and central post-stroke pain.
Sensory issues often respond to sensory reeducation therapy. Central post-stroke pain, however, can be more difficult to treat, but medication may help.
It’s essential to work with your medical team to assess your unique side effects and establish a plan for rehabilitation.
Every stroke is different, so every patient will respond best to different treatment options. Never give up hope.