New-Onset PTSD After Thalamic Infarct

Mr. A, a 70-year-old Korean War veteran with a history of hypertension, was treated for a pure sensory stroke after a lacunar infarct in the left posterior thalamus. Although his sensory symptoms gradually improved, a year after the stroke he started losing interest in his hobbies and became aloof. However, he reported no other depressive symptoms. Four months later, Mr. A suddenly started experiencing repetitive thoughts about a colleague’s suicide, which he had witnessed in 1953. This colleague, although not Mr. A’s buddy or close friend, had the same rank as Mr. A and shared the same dormitory.

Mr. A began feeling anxious and jittery and had difficulty falling asleep. He was startled by the ring of the telephone and began avoiding television programs displaying war scenes. No depressive cognitions, obsessions, flashbacks, delusions, or hallucinations were elicited. His family history was unremarkable, and so was his past psychiatric history, including that for PTSD symptoms, such as reexperiencing, avoidance, or hyperarousal. There was no history of recent trauma or stressors, and he had never thought about this incident before. A repeat cranial computerized tomography scan showed no new findings. Mr. A was diagnosed with PTSD with delayed onset.