Bilateral Thalamic Stroke as a Cause of Decreased Responsiveness

We report the case of a 77-year-old male with no prior history of stroke who came in as a stroke alert for right facial droop and speech slurring, but upon presentation he had decreased responsiveness. Initial imaging for stroke was negative. Laboratory evaluation revealed no abnormalities. As lumbar puncture was about to be performed, the patient had a sudden resolution of symptoms, became responsive, and started answering questions. Magnetic resonance imaging (MRI) revealed small acute infarcts in the bilateral thalami and adjacent central aspect of the midbrain, right larger than the left. General decreased responsiveness needs to be considered in the differential diagnosis of stroke.