The right thalamic ventral posterolateral nucleus seems to be determinant for macrosomatognosia: a case report

BMC Neurology

Jerome Aellen¹  Laura Beer²  Amir H. ElTarhouni²  Britt Erni²  Joelle N. Chabwine³  Ettore Accolla⁴  Sebastian Dieguez⁴  Michael Mouthon⁴  Jean-Marie Annoni⁴ 

[1] Department of Radiology, Fribourg Hospital, Riaz, Switzerland;Division of Neurorehabilitation, Fribourg Hospital, Meyriez, Switzerland;Division of Neurorehabilitation, Fribourg Hospital, Meyriez, Switzerland;Neurology Unit, Department of Neuroscience and Movement Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée, 5, CH-1700, Fribourg, Switzerland;Neurology Unit, Department of Neuroscience and Movement Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée, 5, CH-1700, Fribourg, Switzerland;

关键词: Macrosomatognosia;    Alice in wonderland syndrome;    Thalamus;    Stroke;    Ventral posterolateral nucleus;    Diffusion tractography;   

DOI  :  10.1186/s12883-020-01970-3

来源: Springer

【 摘 要 】

BackgroundMacrosomatognosiais the illusory sensation of a substantially enlarged body part. This disorder of the body schema, also called “Alice in wonderland syndrome” is still poorly understood and requires careful documentation and analysis of cases. The patient presented here is unique owing to his unusual macrosomatognosia phenomenology, but also given the unreported localization of his most significant lesion in the right thalamus that allowed consistent anatomo-clinical analysis.Case presentationThis 45-years old man presented mainly with long-lasting and quasi-delusional macrosomatognosia associated to sensory deficits, both involving the left upper-body, in the context of a right thalamic ischemic lesion most presumably located in the ventral posterolateral nucleus. Fine-grained probabilistic and deterministic tractography revealed the most eloquent targets of the lesion projections to be the ipsilateral precuneus, superior parietal lobule,but also the right primary somatosensory cortex and, to a lesser extent, the right primary motor cortex. Under stationary neurorehabilitation, the patient slowly improved his symptoms and could be discharged back home and, later on, partially return to work.ConclusionWe discuss deficient neural processing and integration of sensory inputs within the right ventral posterolateral nucleus lesion as possible mechanisms underlying macrosomatognosia in light of observed anatomo-clinical correlations. On the other hand, difficulty to classify this unique constellation of Alice in wonderland syndrome calls for an alternative taxonomy of cognitive and psychic aspects of illusory body-size perceptions.

【 授权许可】

CC BY