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NEUROIMAGES
Year : 2016  |  Volume : 64  |  Issue : 6  |  Page : 1377-1378

Conventional MRI demonstration of thalamic internal medullary laminae and a few nuclei in a case of multifocal glioma


Department of Clinical Neurosciences, Indo-American Hospital, Brain and Spine Centre, Chemmanakary, Kerala, India

Date of Web Publication11-Nov-2016

Correspondence Address:
Kamble J Harsha
Department of Clinical Neurosciences, Indo-American Hospital, Brain and Spine Centre, Chemmanakary- 686 143, Vaikom, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.193799

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How to cite this article:
Harsha KJ. Conventional MRI demonstration of thalamic internal medullary laminae and a few nuclei in a case of multifocal glioma. Neurol India 2016;64:1377-8

How to cite this URL:
Harsha KJ. Conventional MRI demonstration of thalamic internal medullary laminae and a few nuclei in a case of multifocal glioma. Neurol India [serial online] 2016 [cited 2019 Aug 26];64:1377-8. Available from: http://www.neurologyindia.com/text.asp?2016/64/6/1377/193799


A 40-year-old female patient presented with an episode of generalized tonic-clonic seizure. Her magnetic resonance imaging (MRI) revealed a multifocal low grade glioma involving the left anterior cingulate gyrus and bilateral thalami. Interestingly, T2-weighted MRI showed the prominence of bilateral internal medullary laminae (IML) of thalami (Right > Left) [Figure 1]. The right internal medullary lamina was extending anteriorly to enclose the anterior group of nuclei (A); and, also extending posteriorly, dividing the ventral posterior nucleus and the pulvinar. The right ventral posterior nucleus had a relative hypointense appearance when compared to the ventral lateral nucleus, with a sharp demarcation existing between the two groups. The imaging findings were suggestive of a “coffee bean” appearance.
Figure 1: (a) Axial T2-weighted image of the brain showing a glioma extending into bithalmic and left cingulate gyral areas, demonstrating the internal medullary lamina of the thalami. The laminar division is visible on the right side with a septa separating the pulvinar from the ventral posterior nucleus. (b) Line diagram of both thalami with labelling of the anatomical structures; A: anterior; VA: ventral anterior; VL: ventral lateral; VPL: ventro-postero-lateral

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Thalamus is a part of the limbic system that connects the cerebral cortex with other parts of the brain. It is structurally composed of several groups of neurons (nuclei), each with its distinct connection. The differentiation between the nuclei is routinely not possible with the conventional MRI sequences. The medial nuclear involvement in isolation or along with the pulvinar is commonly identified in MRI in certain encephalitis (viral,[1] and paraneoplastic [2]) and in Creutzfeldt–Jakob disease.[3] Apart from these conditions, the differentiation between the different groups of nuclei or the demonstration of internal medullary laminae is difficult. The segmentation technique based on tensorial morphological gradient of diffusion tensor imaging is useful in demonstrating thalamic nuclei; however, this technique is mainly limited for research.[4] The prominence of internal medullary lamina in our case was possibly due to it being spared by the glioma. In addition, the differential involvement of the right ventral anterior and lateral nuclei with relative sparing of the ventral posterior nuclei gave the appearance of the presence of separate nuclei groups. Gliomas and glioblastomas have a tendency to spread along the white matter tracts; the differential spread in the current case (by sparing of bilateral internal medullary laminae and relative sparing of the right ventral posterolateral nucleus) had enhanced the gross anatomical details of the thalamic nuclei on conventional MRI. Under normal circumstances, these nuclei would be extremely difficult to identify with the conventional MRI sequences.

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  References Top

1.
Sejvar JJ. Clinical manifestations and outcomes of West Nile virus infection. Viruses 2014;6:606-23.  Back to cited text no. 1
    
2.
Mihara M, Sugase S, Konaka K, Sugai F, Sato T, Yamamoto Y, et al. The “pulvinar sign” in a case of paraneoplastic limbic encephalitis associated with non-Hodgkin's lymphoma. J Neurol Neurosurg Psychiatry 2005;76:882-4.  Back to cited text no. 2
    
3.
Collie DA, Summers DM, Sellar RJ, Ironside JW, Cooper S, Zeidler M, et al. Diagnosing variant Creutzfeldt-Jakob disease with the pulvinar sign: MR imaging findings in 86 neuropathologically confirmed cases. AJNR Am J Neuroradiol 2003;24:1560-9.  Back to cited text no. 3
    
4.
Rittner L, Campbell J, Pike GB, Lotufo R. Segmentation of thalamic nuclei based on tensorial morphological gradient of diffusion tensor fields. Int Symp Biomed Imag 2010;1173-6.  Back to cited text no. 4
    


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