Thalamic stroke mimicking frontotemporal dementia: a case report

Background: The behavioral variant of frontotemporal dementia (bvFTD) is characterized by changes of personality, social behavior and cognition and relies on a neurodegenerative process. However, vascular lesions affecting subcortical structures may result in a clinical syndrome resembling bvFTD. Objective: To describe a case of thalamic stroke resulting in frontal dementia. Case report: A 58-year-old man was referred to our hospital because of behavioral and cognitive changes formerly diagnosed as bvFTD. In 2010, he suddenly presented loss of consciousness and in the next days he developed amnesia, apathy and personality changes. Toxicological exams, CSF analysis and CT scan were normal at admission. Neuropsychological tests showed an impairment of executive functions and amnesia. He was referred to our Center in 2011. Behavioral disturbances and cognitive dysfunctions were already improved since the onset, and at six-month follow-up neuropsychological test showed a further recovery of cognitive functions. Brain MRI showed a left thalamic infarct. Conclusions: The sudden onset and the improvement of clinical signs suggest a vascular origin of the syndrome. The FTD-like picture is attributable to a disruption of the fronto-subcortical circuits at the level of the striatum or the anterior thalamic peduncle. Vascular dementia should be considered in differential diagnosis of bvFTD.