BILATERAL THALAMIC INFARCTS LEADING TO THERMOREGULATORY DYSFUNCTION

Abstract

Bilateral thalamic infarctions are rare cerebrovascular events that disrupt critical neural networks involved in sensory integration, motor regulation, and autonomic stability. Among these, thermoregulatory dysfunction is a complex and often under-recognized complication due to the involvement of thalamic pathways that relay information to the hypothalamus, the body's primary thermoregulatory center. This case highlights a 55-year-old male presenting with neurological deficits and persistent fever unresponsive to conventional antipyretics or antibiotics. Neuroimaging revealed bilateral infarctions in the occipital lobes, cerebellum, thalamus, and right hemipons. The absence of systemic infection and the clinical response to bromocriptine, a dopamine agonist, confirmed the diagnosis of hyperthermia secondary to thalamic infarction. Central hyperthermia following thalamic infarction poses diagnostic and therapeutic challenges due to its nonspecific presentation and resistance to routine fever management. In this case, bromocriptine effectively reduced fever spikes by modulating hypothalamic dopamine receptors, illustrating its therapeutic potential in similar cases. This report highlights the importance of advanced imaging modalities for accurate localization of lesions and a multidisciplinary approach for effective management. Further research into targeted therapies for thalamic infarction-induced dysautonomia is crucial. Timely recognition and intervention are essential to prevent complications and improve patient outcomes in these rare but impactful cases.