GROUP 8

THALAMUS
WRITTEN REPORT
REHAM A. QUE (PART 1)
JAESA QUIRONG (PART 2)
JAIRA DIZZA S. REMITAR (PART 3)
Roles:
- All are reporters
- All are powerpoint makers
- All are researchers
- All are written report makers

PART 1: GENERA APPEARANCE & SUBDIVISIONS

Introduction to Thalamus

- Thalamus or Dorsal Thalamus is situated at the rostral end of the brainstem

and functions as an important relay and integrative station for information
passing to all areas of the cerebral cortex, the basal ganglia, the hypothalamus
and the brainstem . Our thalamus is really important almost every sensation
(with the exception of olfaction) has a nucleus in the thalamus.

The general appearance of the thalamus

- It is large, egg-shaped mass of gray matter that forms the major part of the
diencephalon. So here is the thalamus, notice there is a rather deep groove, the
hypothalamic sulcus that separates the thalamus from the hypothalamus. The
thalamus has 4 surfaces and 2 ends, surfaces : lateral, medial, superior, and
inferior. 2 ends : anterior and posterior. The inferior surface is continuous with
the tegmentum of the brain and the medial surface of the thalamus forms part
of the lateral wall of the third ventricle and is usually connected to the
opposite thalamus by a band of gray matter, the interthalamic connection.

Subdivision of thalamus
- The thalamus is covered on its superior surface by a thin layer of white matter
called the stratum zonal, and on its lateral surface by another layer, the
external medullary lamina.
- coronal section of the brain, coronal section is one that separates the brain
into anterior and posterior halves,

a. One very typical feature that you see in coronal section of the brain is a
T shape formation, with the third ventricle forming the vertical part of
the T and
b. Lateral ventricles forming the horizontal parts of the T. Septum
pellicidum which is separating the lateral ventricles from each other
and here we see surrounding the third ventricles the two halves of the
thalamus,
c. The third ventricle is the continuation of the ventricular system in the
brain and is responsible for producing (by way of choroid plexus) and
conveying cerebrospinal fluid.
 d. Sitting above the horizontal part of the T is the very clear fibers of the
corpus callosum connecting the two hemispheres.
e. External medullary lamina defines the lateral boundary of the
thalamus.
f. Internal medullary lamina runs longitudinally through the thalamus,
divide the thalamic nuclei into anterior, lateral and medial groups.
Contain fibers that interconnect different thalamic nuclei.
g. At the rostral end of the thalamus the anterior nucleus. It plays a role as
the primary relay nucleus of the limbic system.
h. Lateral to the intralaminar nuclei are the lateral dorsal nucleus which
similarly to the anterior nucleus is involved in limbic function.
i. Located medial to the internal medullary lamina is the dorsomedial
nucleus of the thalamus which receives input from other thalamic
nuclei. Concerned with affective behavior and memory.

- Nuclei of the Thalamus

 Thalamus has 2 ends and this are the anterior and posterior ends, anterior end
of the thalamus is narrow and rounded and forms the posterior boundary of the
interventricular foramen and the posterior end is expanded to form the
pulvinar, which overhangs the superior colliculus, A y shape in between the
divisions these are the white matter fibers that actually divide the thalamus,
the y-shaped white matter is the internal medullary lamina , The thalamus thus
is subdivided into three main parts, the anterior part lies between the limbs of
the Y, and the medial and lateral parts lie on the sides of the stem of the y.
a) Anterior division comprised only of the anterior nucleus,
b) Medial division comprised of the dorsal medial nucleus ,
c) The lateral division has two tiers the dorsal tier of the lateral division it has
three nuclei the lateral dorsal, the lateral posterior and the pulvinar nucleus,
d) The ventral tier of the lateral division it has four nuclei starting at the anterior
aspect the ventral anterior, the ventral lateral, the ventral posterior nucleus
subdivided into ventral posteromedial nucleus and the the ventral
posteromedial nucleus, and
e) Two additional nucleus they are the medial geniculate and lateral geniculate
nuclei.

PART 2: CONNECTIONS & FUNCTIONS

THALAMUS
-Receives information from the sensory system, motor systems, limbic system,
reticular formation.
-After processing, there will be an output of the thalamic network that is going to
convey the information to the cerebral cortex.
-When this happens, the cerebral cortex itself will send back information to modulate
the thalamic function. This would indicate that information received by the thalamus
is always shared with the cerebral cortex and that the cortex and thalamus can modify
each other's activities

THALAMIC NUCLEI: CONNECTIONS AND FUNCTIONS

ANTERIOR NUCLEUS- Receives input from the mammillary body, cingulate gyrus
and hypothalamus and the output goes to the limbic group, particularly the cingulate
gyrus and the hypothalamus.
The function of the anterior thalamic nuclei is closely associated with that of the
limbic system and is concerned with emotional tone and the mechanisms of recent
memory
DORSOMEDIAL-The dorsomedial nucleus has two-way connections with the whole
prefrontal cortex of the frontal lobe of the cerebral hemisphere, hypothalamic nuclei.
And with all the other groups of thalamic nuclei. The output is going to the prefrontal
cortex (Area of 9,10,11,12), hypothalamus and to the other thalamic nuclei.
This nucleus is responsible for the integration of a large variety of sensory
information, including somatic, visceral, and olfactory information, and the relation of
this Information to one's emotional feelings and subjective states.
LATERAL
DORSAL TIER:
The dorsal tier includes the LATERAL DORSAL NUCLEUS, the LATERAL
POSTERIOR NUCLEUS, and the PULVINAR. The details of the connections of
these nuclei are not clear. They are known, however, to have interconnections with
other thalamic nuclei and with the parietal lobe, cingulate gyrus, and occipital and
temporal lobes.
VENTRAL TIER:
VENTRAL ANTERIOR NUCLEUS- receives information from the Basal ganglia
(substancia nigra), reticular formation, the corpus striatum, and the premotor cortex as
well as to many of the other thalamic nuclei. This nucleus influences the activities of
the motor cortex
VENTRAL LATERAL NUCLEUS- has connections similar to the Ventral Anterior
but, has a major input in the Cerebellum and a minor input from the red nucleus. The
output will be sent to the motor and pre-motor area. This influences the activities of
the motor cortex.
VENTRAL POSTEROMEDIAL- Receives information from the ascending
trigeminal lemniscus and gustatory fibers. It sends output to the primary somatic
sensory cortex (Areas 3,2,1). This relays common sensations to consciousness.
VENTRAL POSTEROLATERAL-Receives the important ascending sensory tracts,
the medial and spinal lemnisci. And sends output to the primary somatic sensory
cortex (Areas 3,2,1). This also relays common sensations to consciousness.
OTHER NUCLEI:
INTRALAMINAR NUCLEI- They receive afferent fibers from the reticular
formation as well as fibers from the spinothalamic and trigeminothalamic tracts; they
send efferent fibers to other thalamic nuclei, which in tum project to the cerebral
cortex, and fibers to the corpus striatum. The nuclei are believed to influence the
levels of consciousness and alertness ln an Individual.
RETICULAR NUCLEUS- Afferent fibers converge on this nucleus from the
cerebral cortex and the reticular formation, and Its output is mainly to other thalamic
nuclei. The function of this nucleus is not fully understood, but it may be concerned
with a mechanism by which the cerebral cortex regulates thalamic activity.
MIDLINE NUCLEI- consist of groups of nerve cells adjacent to the third ventricle
and in the interthalamic connection. They receive afferent fibers from the reticular
formation. Their precise functions are unknown.
MEDIAL GENICULATE BODY- Afferent fibers to the medial geniculate body
form the Inferior brachium and come from the inferior colliculus. It should be
remembered that the inferior colliculus receives the termination of the fibers of the
lateral lemniscus. The medial geniculate body receives auditory information from
both ears but predominantly from the opposite ear. This nucleus is more related to
hearing.
LATERAL GENICULATE BODY- This receives information from the optic tract
and the output is sent to the visual cortex of the occipital lobe (Area 17). The function
involves in the visual information from the opposite field of vision.
IMPORTANT FUNCTIONS OF THALAMUS:
 SENSORY INTEGRATION- it is the relay station for all sensations except
OLFACTION.
 MOTOR INTEGRATION-it connects cerebral cortex with basal ganglia and
cerebellum.
 MOOD-connected with the limbic system
 CONSCIOUSNESS AND ALERTNESS- connected with the reticular
formation
 PERSONALITY-connected with the frontal lobe cortex and hypothalamus

PART 3: CLINICAL NOTES & PROBLEM

1. Lesions
Because the thalamus is such an important relay and integrative center, disease of this
area of the central nervous system will have profound effects. The thalamus may be
invaded by neoplasm, undergo degeneration following disease of its arterial supply, or
be damaged by hemorrhage.

Etiology
While vascular accidents, either hemorrhagic or ischemic, are the most common
etiologies causing acute thalamic lesions

Other reported etiologies include:

-Migraine
-Metabolic (e.g., thiamine deficiency),
-Inflammatory (e.g., cerebral lupus), -Infectious (e.g., bacterial abscesses, cerebral
syphilitic gumma)
-Traumatic
-Neoplastic (e.g., tumors or cysts)
-Iatrogenic (e.g., deep brain stimulation)

Risk Factors(for acute thalamic lesions) Include the common vasculopathic risk
factors:
-Hypertension
-Diabetes
-History of smoking

2. Sensory Loss
These lesions usually result from thrombosis or hemorrhage of one of the arteries
supplying the thalamus. Damage to the ventral posteromedial nucleus and the ventral
posterolaleral nucleus will result in the loss of all forms of sensation, including light
touch, tactile localization and discrimination, and muscle joint sense from the
opposite side of the body. The thalamus is centrally located among other import
ant nervous structures. Usually, a thalamic lesion results in dysfunction of
neighboring structures, producing symptoms and signs that overshadow those
produced by the thalamic disease. For example, a vascular lesion of the thalamus may
also involve the midbrain, with resulting coma, or a lateral extension of thalamic
disease may involve the internal capsule and produce extensive motor and sensory
deficits.

3. Thalamic Pain
- Thalamic pain is a severe and treatment-resistant type of central pain that may
develop after thalamic stroke. Lesions within the ventrocaudal regions of the thalamus
carry the highest risk to develop pain.
- is often excessive (thalamic overreaction), occurs on the opposite side of the body.
- The painful sensation may be aroused by light touch or by cold and may fail to
respond to powerful analgesic drugs.

Surgical Relief of Pain by Thalamic Cauterization:

The intralaminar nuclei of the thalamus are known to take part in the relay of pain to
the cerebral cortex. Cauterization of these nuclei has been shown to relieve severe and
intractable pain associated with terminal cancer.

4. Abnormal Involuntary Movements

Choreoathetosis with ataxia may follow vascular lesions of the thalamus. Whether
these signs in all cases are due to the loss of function of the thalamus or to
involvement of the neighboring caudate and lentiform nuclei is not certain. The ataxia
may arise as the result of the loss of appreciation of
muscle and joint movement caused by a thalamic lesion.

5. Thalamic Hand
The contralateral hand is held in an abnormal posture in some patients with thalamic
lesions. The wrist is pronated
and flexed, the metacarpophalangeal joints are flexed, and the interphalangeal joints
are extended. The fingers can
be moved actively, but the movements are slow. The condition is due to altered
muscle tone in the different muscle groups.

CLINICAL PROBLEMS:
1. A 61 years old man with hypertension is seen in the emergency department,
having apparently suffered a stroke. A neurologist is called and makes a complete
examination of the patient. The patient is conscious and is unable to feel any sensation
down the right side of his body. No evidence of paralysis is noted on either side of the
body, and the reflexes are normal. The patient is admitted to the hospital for
observation.
Three days later, the patient appears to be improving, and return of sensation is
evident on the right side of his body. The patient, however, seems to be excessively
sensitive to testing for sensory loss. On light pinprick on the lateral side of the right
leg, the patient suddenly shouts out because of excruciating burning pain, and he asks
that the examination be stopped. Although the patient experiences very severe pain
with the mildest stimulation, the threshold for pain sensitivity is raised, and the
interval between applying the pinprick and the start of the pain is longer than
normal; also, the pain persists after the stimulus has been removed. Moreover, the
patient volunteers the information that the pain appears to be confined to the skin and
does not involve deeper structures. Later, heat and cold stimulation are found to cause
the same degree of discomfort.

ANSWER: The neurologist makes the diagnosis of analgesia dolorosa or Dejerine

Roussy syndrome involving the left thalamus. This condition of thalamic overreaction
is most commonly caused by infarction of the lateral nuclei of the thalamus due to
hypertensive vascular disease or thrombosis.

2. A 45-year-old man who has suddenly developed weakness of the left leg 12 hours
previously is admitted to a medical ward. On examination, he is found to have
paralysis of the left leg and weakness of the muscles of the left arm. The muscles of
the affected limbs show increased tone, and tendon reflexes are exaggerated on the
left side of the body. Also, considerable sensory loss on the left side of the body
involves both the superficial and deep sensations. During the examination, the patient
exhibits spontaneous jerking movements of the left leg. When asked to touch the tip
of his nose with the left index finger, he demonstrated considerable intention tremor.
The same test with the right arm shows nothing abnormal. Three days later, the
patient starts to complain of agonizing pain down the left leg. The pain starts
spontaneously or is initiated by the light touch of the bed sheet. What is your
diagnosis? How can you explain the various signs and symptoms?

ANSWER: This man had a thrombosis of the thalamogeniculate branch of the right
posterior cerebral artery. This resulted in a degenerative lesion within the right
thalamus, causing the impairment of superficial and deep sensations on the left side of
the body.
- The contralateral hemiparesis, involving the left leg and left arm with increased
muscle tone, was produced by edema in the nearby posterior limb of the right internal
capsule, causing blocking of the corticospinal fibers. As the edema resolved, the
paralysis and spasticity improved.
- The choreoathetoid movements of the left leg and the intention tremor of the left
arm were probably due to damage to the right thalamus or to the right dentatothalamic
nerve fibers.
- The agonizing pain felt down the left leg was due to the lesion in the right thalamus.