1444 - Rehabilitation in a Hemisensory Thalamic Stroke Posing as Hemiparesis: A Case Report

Case Diagnosis: Right thalamic stroke

Case Description: A 69-year-old male was admitted to acute rehabilitation with reported left hemiparesis and left hemianesthesia. Prior MRI revealed an acute right thalamic stroke located near the ventral postero-lateral nucleus. On admission to acute rehabilitation, physical examination demonstrated mixed sensory changes of light touch, vibration, pain, and temperature in a left hemibody pattern. The patient subjectively complained of left arm and leg weakness; however, the patient’s strength was full when reinforced with visual and verbal cueing during strength examination. Rather, the patient demonstrated complete loss of proprioception of his left side resulting in discoordination of motor control. Consequently, a therapy regimen was ordered targeting sensory and proprioceptive deficits. The patient showed significant improvements in coordination and motor skills following his two-week rehabilitation program.

Discussions: Impairments observed after a thalamic stroke are highly variable and often present with mixed motor and sensory deficits. Unique to this case is a pure hemisensory thalamic stroke with complete unilateral proprioception loss masquerading as motor weakness. This presentation demonstrates the significant impact that afferent sensory and proprioceptive feedback have on efferent motor control. A detailed physical examination must be completed to distinguish between proprioceptive deficits and true motor weakness. Furthermore, literature reflecting acute rehabilitation strategies for thalamic stroke patients with isolated hemianesthesia is lacking. Our patient completed a targeted therapy program including proprioceptive taping, visual cueing with motor tasks, transcutaneous electrical nerve stimulation (TENS), weight-bearing exercise, and exoskeleton utilization. Our patient’s significant return of motor coordination upon discharge suggests that the use of these modalities provides proprioceptive feedback to facilitate motor relearning.

Conclusions: Pure hemisensory thalamic strokes with loss of proprioception can be mistaken for motor weakness. Acute rehabilitation therapy targeting sensory and proprioceptive deficits provides benefit for relearning motor skills.