The occlusion of the artery of Percheron (AOP) is a rare condition that causes bilateral thalamic ischemic stroke with or without midbrain involvement. It happens as a result of an anatomical variant of the diencephalic irrigation, in which the thalamic paramedian arteries arise from a common trunk from the posterior cerebral artery (PCA), which generates a clinical syndrome characterized by bilateral vertical gaze palsy, memory impairment and hypersomnia. In this case, we report a 62-year-old woman admitted to the emergency room with altered mental status, mainly somnolence. On physical examination, she was somnolent, apathetic and with no motor deficit. Magnetic resonance imaging (MRI) of the brain demonstrated bilateral thalamic hyperintensities and midbrain involvement in diffusion-weighted imaging (DWI) and T2 sequences, suggesting occlusion of the AOP. Bilateral thalamic infarction due to this anatomical variant is an entity with a low prevalence, and its diagnosis can be delayed because of the wide spectrum of clinical signs.

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Tuberculous Meningitis (TBM) is the infection of the meninges by Mycobacterium tuberculosis (Mtb) [1]. First described by Green in 1836 [2], TBM is the most common form of central nervous system tuberculosis (TB), accounting for 5-6% of extrapulmonary TB cases and for 1% of the total TB cases worldwide [1,3,4]. TBM is described as a subacute illness with a duration of symptoms that ranges 5-30 days with clinical features such as a low-grade fever, headache, and signs of meningeal irritation; in advanced stages, there may be focal neurological deficits, cranial nerve paralysis, and seizures [1,5,6]. The global incidence of TBM is unknown [7]; in 2017, Mexico had an overall prevalence of 0.35 cases per 100,000 inhabitants [8]. The global HIV epidemic has increased the number of adults affected by TBM. Data from a study that included a database of 1699 adult patients from five different studies reported a mortality rate of 23% in non-HIV patients and 51.3% for HIV-infected patients [9], reaching 100% in cases of drug-resistant Mtb [3]. Despite its high incidence, to our knowledge, the clinical features and outcome of the Mexican adult population with TBM have not been described. The aim of this study is to describe the characteristics at admission and in-hospital outcome of adult Mexican patients with TBM and compare them according to the subtype of diagnosis.

Monoballism secondary to a mixed hyperglycemic crisis is a rare initial symptom of new-onset diabetes, which commonly affects the elderly and Asian women having inadequate glycemic control. In hyperglycemic states, the elevated serum glucose levels raise the viscosity of the blood reducing cerebral perfusion, decreasing gamma-aminobutyric acid levels, the latter being an inhibitory neurotransmitter of thalamocortical stimuli. In this case, we report a previously healthy 41-year-old male who attended the emergency department because of an abrupt onset movement disorder of the left arm, this being compatible with monoballism. He was diagnosed with a mixed hyperglycemic crisis.

Conduction aphasia being the arcuate fasciculus of the site of structural injury is a speech disorder characterized by fluent, spontaneous speech and paraphasias, intact auditory comprehension, and limited repetition. One of the causes of stroke in young adults is the Mycobacterium tuberculosis (MTB) infection, which may cause cerebral ischemia secondary to artery obliteration. In this case report, we present a previously healthy 24-year-old woman that presented with a sudden onset of aphasia; MTB was identified as the etiological agent. Tuberculous meningitis (TBM) has a wide range of clinical manifestations with aphasia being one of the rarest forms of initial presentation.