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Why does damage to the thalamic nuclei lead to a coma?

In principle, it can be argued that the thalamus (or thalamus) is a subcortical center through which all types of sensitivity pass - visual, auditory, skin-kinesthetic, as well as introceptive (sensitivity of receptors located in internal organs). In the thalamus, stimuli from the external and internal environment are integrated, after which they enter the cerebral cortex.

The nuclei of the thalamus are functionally divided into three classes: specific, nonspecific and associative.

Signals from receptors in the skin, eyes, ear and muscular system go to specific nuclei of the thalamus. The main function of the neurons that make up specific nuclei is to switch information going to the PD cortex from the corresponding receptors.

Local damage to certain specific nuclei leads to loss of the types of sensitivity corresponding to the affected area.

The associative nuclei of the thalamus are connected, among other things, with the associative zones of the cerebral cortex, which connect newly received sensory information with previously received and stored in memory, and also compare information received from different receptors. Sensory signals are interpreted and used to determine the most appropriate responses, which are selected in the association area and transmitted to its associated motor area.
The nonspecific nuclei of the thalamus, among other things, are closely connected with many brain systems, incl. with the reticular formation, and play an important role in regulating the processes of neuron activation, regulation of sleep and wakefulness.

Thus, the nuclei of the thalamus are involved in various types of mental activity: all sensory information from the external and internal environment comes here, is integrated and transmitted to higher levels, incl. to the associative, and then to the motor zones of the cortex, which ensures the formation of various motor reactions that are integrated with the vegetative processes that ensure these movements; here, information is exchanged with the energy block of the brain, which regulates the corresponding nervous activity necessary for the execution of motor programs.

Lesions of the thalamic nuclei, caused by mechanical damage or organic pathologies, can disrupt all of the above processes and, depending on the severity, can lead to complete loss of sensitivity and motor activity (coma).

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Elias A. Giraldo

, MD, MS, California University of Science and Medicine School of Medicine

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Table 2)

Stroke is a heterogeneous group of diseases caused by a sudden focal cessation of cerebral blood flow, which causes the development of neurological disorders. Strokes can be

ischemic (80%), usually as a result of thrombosis or embolism

Temporary stroke symptoms (usually lasting 1 hour) without evidence of acute cerebral infarction (based on diffusion-weighted MRI) are called transient ischemic attack (TIA).

In the United States, stroke is the fifth leading cause of death and the most common cause of neurological disability in adults.

When a stroke occurs, the arteries of the brain are affected (Cerebral arteries) or the anterior vascular system (branches of the internal carotid artery) or the posterior vascular system (branches of the vertebral and basilar arteries).

Arteries of the brain.

The anterior cerebral artery supplies the medial part of the frontal and parietal lobes and the corpus callosum. The middle cerebral artery supplies blood to most of the frontal, parietal and temporal lobes. The branches of the anterior and middle cerebral arteries (lenticulostriate arteries) supply blood to the basal ganglia and the anterior limb of the internal capsule.

The vertebral and basilar arteries supply the brain stem, cerebellum, posterior cerebral cortex, and mediobasal temporal region. The main artery divides into two posterior cerebral arteries to supply blood to the mediobasal regions (including the hippocampus) of the temporal region and occipital lobe of the brain, thalamus, mastoid and geniculate bodies.

The anterior and posterior vascular beds are connected in the circle of Willis.

Cores

The thalamus is part of a complex complex. It is formed from four parts. These include: the hypothalamus, epithalamus, prethalamus, and dorsal thalamus. The last two are derived from the intermediate structure. The epithalamus consists of the pineal thala, triangle and leashes. This area contains the nuclei involved in the activation of the sense of smell. The ontogenetic nature of the epithalamus and perithalamus is different. In this regard, they are considered as separate entities. In general, the structure of the thalamus includes more than 80 nuclei.

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Clinical manifestations

The initial symptoms of a stroke develop suddenly. The most common symptoms of stroke include numbness, weakness or paralysis of the contralateral limbs and half of the face, aphasia, confusion, visual disturbances in one or both eyes (for example, transient blindness in one eye), dizziness or loss of stability and coordination, and headache.

The nature of the neurological symptoms corresponds to the location of the lesion (see table Some Symptoms of Stroke). Stroke of the blood supply to the anterior part of the brain usually causes unilateral symptoms. A stroke in the posterior vascular system can cause unilateral or bilateral disorders, often with impaired consciousness, especially when the basilar artery is affected.

Some symptoms of a stroke

Contralateral hemiparesis (predominantly involving the leg), urinary incontinence, aspontaneity, confusion, impaired logical thinking, mutism, grasp reflex, gait apraxia

Anterior cerebral artery (rare)

Contralateral hemiparesis (with more pronounced involvement of the arm and face compared to the leg), dysarthria, hemianesthesia and homonymous hemianopsia on the opposite side, aphasia (if the dominant hemisphere is affected) or apraxia and half-space neglect (if the non-dominant hemisphere is affected)

Middle cerebral artery (common)

Contralateral homonymous hemianopsia, unilateral cortical blindness, amnesia, unilateral palsy of the third pair of cranial nerves, hemiballismus

Posterior cerebral artery

Unilateral vision loss (amaurosis)

Ophthalmic artery (branch of the internal carotid artery)

Nerve pathways

The thalamus is a formation associated with the hippocampus. The interaction is carried out through a special tract in which the fornix and mastoid bodies are present. The thalamus is connected to the cortex by thalamocortical rays. There is also a path through which information about itching, touch, and temperature is transmitted. It runs in the spinal cord. There are two sections: ventral and lateral. The first carries impulses about pain and temperature, the second - about pressure and touch.