Bithalamic infarct causing acute consciousness disturbance. Early diagnosis with diffusion-weighted MRI

Fast diagnostic evaluation of somnolent or unconscious patients is a demand ing task for neurologists. Apart from postictal, metabolic, and toxic cause s,vascular syndromes must be rapidly identified in order to initiate a spec ific fibrinolytic therapy. Given its high mortality if not treated in time, this dictum holds especially true for basilar artery occlusion. However, ce rtain ischemic lesions in the vascular territory of the basilar artery with out occlusion of the basilar artery itself can also result in somnolence, s opor, or even unconsciousness. Here we report early imaging signs of bithal amic infarctions as the cause of acute sopor using diffusion-weighted (DW)- MRI, which reliably identifies acute bithalamic infarctions as a possible c ause of acute consciousness disturbance, even with noncooperative patients.