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.