Thalamic chronotaraxis: isolated time disorientation

Background

Acute isolated disorientation of time, chronotaraxis, is an uncommon manifestation of thalamic stroke. To our knowledge, acute thalamic chronotaraxis with MRI findings has not previously been reported.

Objective

To describe five patients with chronotaraxis after thalamic stroke and attempt to demonstrate the correlation between lesion location and neurological findings.

Patients, methods and results

Isolated time disorientation and loss of time sense were found in five of 120 patients (4%) with ischaemic thalamic stroke in our centre. All patients had disorientation to actual date, inability to know the exact time of the day and under or overestimation of the time passed during examination. Patients expressed themselves as having time blindness with an inability to estimate and guess the actual time.

Conclusion

Acute thalamic chronotaraxis is a specific clinical picture that accurately predicts a small artery disease of the thalamus involving the mediodorsal nucleus of the thalamus. This clinical syndrome appears to have a good clinical recovery.Disorientation of time, place and person, and distortion of personal and extrapersonal memory systems may occur after mediodorsal thalamotomy, and may also be observed in paramedian or polar artery infarction.^1,2 Isolated prominent disorientation of time is extremely rare, and the term chronotaraxis has been used to describe this phenomenon.³ The meaning of the Greek name chronotaraxis is distortion or disorientation of the sense of time, such as for dates, seasons of the year, times of the day, and overestimation or underestimation of duration of time.We present a consecutive series of five patients with chronotaraxis, and attempt to clarify the correlation between lesion location and related behavioural findings.