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A 68 year old woman developed intermittent somnolence and dysarthria. Four days later she was alert but disoriented and developed stereotypic behaviours such as constantly packing her belongings. Brain MRI showed bilateral symmetric thalamic infarcts. Magnetic resonance angiography and an echocardiogram were normal.
In one third of patients, the thalamic-subthalamic arteries arise from one side or from a common pedicle. In such cases an acute occlusion will lead to bilateral posteromedial thalamic infarcts that can be followed by a thalamic dementia.1