A bilateral basal ganglia infarct: a case study emphasizing the importance of function and stroke outcomes
Location
Suwanee, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 AM
Description
Introduction: Bilateral basal ganglia infarcts are considered rare occurrences and would be expected to present with substantial deficits, including motor, behavioral, and cognitive changes. Generally, basal ganglia infarcts can be caused by chronic hypertension, substance abuse, and hypercoagulable states. Due to the rarity of bilateral basal ganglia infarcts, there is limited information regarding a standardized presentation, outcomes, and functional recovery.
Objectives: The objective of this case is to highlight a rare stroke presentation with an emphasis on assessing deficits, functionality, and recovery as a form of stroke rehabilitation management. This case also aims to represent the variable relationship between strength and function, as well as signs of infarct progression.
Methods: This is an observational case study. The patient’s chart was thoroughly reviewed, and a review of additional case reports and literature was completed to evaluate the case.
Results: A 58-year-old female with a past medical history of systemic lupus erythematosus, highly suspected antiphospholipid syndrome, paroxysmal atrial fibrillation, hypertension, hyperlipidemia, and obesity presented to the emergency room. The patient was found to have a bilateral basal ganglia infarct involving the head of the caudate nucleus on CT, and these findings were confirmed by follow-up MRI. Moreover, there was no thrombus visualized on the echocardiogram upon initial hospital evaluation.
Prior to this, the patient was functionally independent without a history of thromboembolic events or debility. During the initial physical and occupational therapy evaluations, the patient required varied levels of assistance ranging from maximal to minimal assistance on mobility tasks and activities of daily life, 4-/5 bilateral upper extremity strength, 2/5 bilateral lower extremity strength, and 1/4 deep tendon reflexes in bilateral upper and lower extremities. After 2 weeks, the patient was transferred to an acute rehabilitation center, where she presented with similar mobility findings and fatigue. Despite her assistance needs and initial hypoarousal, the patient was able to ambulate 30-40ft using a rolling walker with standing breaks. The patient’s family reported the ability for her to communicate verbally; however, it was only documented that the patient was able to nod her head yes or no.
After 4 days in an acute rehabilitation facility, the patient demonstrated a progressive decline, indicated by worsening dysphagia, somnolence, and regression of mobility. The patient was readmitted to the hospital with the discovery of an acute bilateral thalamic infarct.
Conclusion: This case highlights the consideration of various clinical presentations for bilateral basal ganglia infarcts and emphasizes the need for a comprehensive review of patients to aid in determining useful prognostic factors of function and recovery. Generally, in post-stroke patients, strength is a positive prognostic indicator; however, it does not reliably predict patient functionality or debility, emphasizing the necessity for comprehensive functional assessments and follow-up. Lastly, this case emphasizes how unexpected functional declines warrant reevaluations for the possible infarct progression or the presence of a new stroke.
Embargo Period
5-13-2026
A bilateral basal ganglia infarct: a case study emphasizing the importance of function and stroke outcomes
Suwanee, GA
Introduction: Bilateral basal ganglia infarcts are considered rare occurrences and would be expected to present with substantial deficits, including motor, behavioral, and cognitive changes. Generally, basal ganglia infarcts can be caused by chronic hypertension, substance abuse, and hypercoagulable states. Due to the rarity of bilateral basal ganglia infarcts, there is limited information regarding a standardized presentation, outcomes, and functional recovery.
Objectives: The objective of this case is to highlight a rare stroke presentation with an emphasis on assessing deficits, functionality, and recovery as a form of stroke rehabilitation management. This case also aims to represent the variable relationship between strength and function, as well as signs of infarct progression.
Methods: This is an observational case study. The patient’s chart was thoroughly reviewed, and a review of additional case reports and literature was completed to evaluate the case.
Results: A 58-year-old female with a past medical history of systemic lupus erythematosus, highly suspected antiphospholipid syndrome, paroxysmal atrial fibrillation, hypertension, hyperlipidemia, and obesity presented to the emergency room. The patient was found to have a bilateral basal ganglia infarct involving the head of the caudate nucleus on CT, and these findings were confirmed by follow-up MRI. Moreover, there was no thrombus visualized on the echocardiogram upon initial hospital evaluation.
Prior to this, the patient was functionally independent without a history of thromboembolic events or debility. During the initial physical and occupational therapy evaluations, the patient required varied levels of assistance ranging from maximal to minimal assistance on mobility tasks and activities of daily life, 4-/5 bilateral upper extremity strength, 2/5 bilateral lower extremity strength, and 1/4 deep tendon reflexes in bilateral upper and lower extremities. After 2 weeks, the patient was transferred to an acute rehabilitation center, where she presented with similar mobility findings and fatigue. Despite her assistance needs and initial hypoarousal, the patient was able to ambulate 30-40ft using a rolling walker with standing breaks. The patient’s family reported the ability for her to communicate verbally; however, it was only documented that the patient was able to nod her head yes or no.
After 4 days in an acute rehabilitation facility, the patient demonstrated a progressive decline, indicated by worsening dysphagia, somnolence, and regression of mobility. The patient was readmitted to the hospital with the discovery of an acute bilateral thalamic infarct.
Conclusion: This case highlights the consideration of various clinical presentations for bilateral basal ganglia infarcts and emphasizes the need for a comprehensive review of patients to aid in determining useful prognostic factors of function and recovery. Generally, in post-stroke patients, strength is a positive prognostic indicator; however, it does not reliably predict patient functionality or debility, emphasizing the necessity for comprehensive functional assessments and follow-up. Lastly, this case emphasizes how unexpected functional declines warrant reevaluations for the possible infarct progression or the presence of a new stroke.