Bilateral paramedian thalamic infarction presenting with atypical pseudobulbar effect: a diagnostic challenge

Bilateral thalamic infarction is a rare subtype of ischemic stroke often resulting from occlusion of artery of Percheron (AOP), diagnosed after excluding alternative arterial, venous & non-vascular etiologies. Altered sensorium and abnormalities in eye movements are common manifestations. We present the case of a 31-year-old woman attending our tertiary care hospital with presentation of sudden onset altered mentation associated with pseudobulbar affect and dysarthria. Her neuroimaging exhibited bi-thalamic infarcts. The clinical diagnosis of this entity remains challenging, particularly when classical symptoms are lacking.