Background:
Thalamic stroke demonstrates clinical heterogeneity in presenting symptoms. Sensory thalamic stroke is frequently misdiagnosed due to positive or spreading sensory symptoms that resemble epileptic seizure or migraine aura. Involvement of the ventral posterolateral (VPL) and ventral posteromedial (VPM) nuclei may produce isolated hemisensory symptoms without motor deficits, resulting in under recognition of stroke and classification as a stroke mimic.
Methods:
We present two patients with acute thalamic stroke presenting with atypical sensory symptoms initially considered non-vascular mimics. Clinical presentation, neuroimaging findings, vascular risk factors, and stroke aetiology were reviewed and contextualised with a focused literature review of sensory thalamic stroke syndromes and vascular territories.
Results:
Both patients presented with hemisensory symptoms, including facial and limb sensory disturbance with a Jacksonian‑type sensory march. One patient presented with progressive sensory disturbance beginning in the face and spreading to the upper limb over seconds, described as a “water‑like” sensation. The second patient reported transient facial sensory change, imbalance and usual "running water" positive visual phenomena. There were minimal objective deficits on initial examination and subsequent magnetic resonance imaging (MRI) confirmed thalamic infarction. Stroke aetiology was consistent with small-vessel disease or atherosclerosis.
Conclusions:
These cases highlight the diagnostic value of MRI in patients with atypical neurological symptoms differentiate stroke mimics from ischaemic events. Thalamic infarction should be considered in patients with vascular risk factors presenting with acute, spreading sensory disturbances. Familiarity with thalamic sensory anatomy and characteristic symptom evolution may reduce misdiagnosis, facilitate acute management and enable timely secondary prevention.