目的:提高对以双侧丘脑病变为主要表现的神经系统疾病的临床认知水平。

方法:报道1例以"行走不稳伴言语异常"为主要临床表现,具有双侧丘脑病变患者的诊疗经过,同时结合文献,重点针对其病因及临床表现等方面的相关研究进展进行综述。

结果:该例丘脑病变患者以意识障碍、言语行走功能障碍为主要表现,经过相关影像学检查在双侧丘脑发现对称病灶,最终诊断为后循环脑梗死,基底动脉尖综合征。

结论:双侧丘脑病变临床上并不罕见,临床表现受病变部位、其他大脑组织部位有否合并受累等影响。其病因众多,包括肿瘤、感染或脱髓鞘疾病、代谢或中毒性疾病以及需要及时干预的血管性疾病。因缺乏具特征性的临床症状表现,为临床诊断及鉴别带来一定困难。因此,早期明确丘脑病变病因尤为重要,以期能够早诊断早治疗,本文在报导病例的同时就其病因和临床表现等方面的研究进展进行综述。

Objective:To improve the understanding of nervous system diseases with bilateral thalamic lesions as the main manifestation.

Methods:Report a clinical diagnosis and treatment of a patient with main manifestations of “walking instability and speech abnormality" and bilateral thalamic lesions. The relevantresearch progress of its etiology and clinical manifestations is discussed based on literature review.

Results:The patient with bilateral thalamic lesions who presented with consciousness disturbance, speech and walking dysfunction. Symmetrical lesions were found in the bilateral thalamus through MRI and the patient was finally diagnosed as posterior circulation cerebral infarction and top of the basilar syndrome (TOBS).

Conclusion:Bilateral thalamic lesions are not clinically rare, and the clinical presentations vary by the affected lesion site and whether other brain tissues are involved. The etiologies include tumors, infections, demyelinating disorders, metabolic, toxic diseases and vascular diseases that require immediate intervention. Due to the lack of distinguishing clinical signs and symptoms, clinical diagnosis and differential diagnosis are complicated. Therefore, it is particularly important to identify the etiology of thalamic lesions at an early stage to enable early diagnosis and treatment. In this case, the etiology and clinical manifestations of thalamic lesions were well reviewed besides case report.