Bilateral paramedian thalamic and midbrain infarction due to occlusion of the artery of percheron in an elderly male: a case report

Qian, Juanfeng; Wu, Chuanjie; Peng, Jing; Liu, Hongbo

doi:10.1007/s10072-017-2860-6

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…In certain instance, both thalamic nuclei are supplied by a single end perforator called artery of Percheron. [14] We confidently diagnose this case with an artery of Percheron infarction as a cause of severe bradycardia and coma for a number of reasons. One, the MRI pattern of bilateral paramedian thalamic and midbrain infarction is the most common finding in this type of infarction.…”

Section: Discussionmentioning

confidence: 97%

“…The artery of Percheron arises as a single common trunk from one of the posterior cerebral arteries (PCA), and provides a bilateral arterial blood supply to the paramedian thalamic and rostral midbrain. [614] Artery of Percheron variance is rare, with an incidence of 11.7% from cadaveric study. [6] The most common clinical presentations are coma and ocular movement disorders.…”

Section: Introductionmentioning

confidence: 99%

“…Alterations of consciousness from a bilateral thalamic infarction is prevalent in the literature,[1314] whereas only one case has been reported having severe bradycardia. [12] We demonstrate a case with coma, ocular gaze palsy, and severe bradycardia following infarction of the artery of Percheron.…”

Section: Introductionmentioning

confidence: 99%

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Artery of Percheron infarction results in severe bradycardia: A case report

Asavaaree¹,

Doyle²,

Smithason³

2018

Surg Neurol Int

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Background:The thalamus is normally supplied by each posterior cerebral artery (PCA). The artery of percheron is a variant of this anatomy as it arises as a single trunk unilaterally from the PCA to supply the thalamus bilaterally. Occlusion of this artery is rare, and the diagnosis is usually missed without obtaining an MRI.Case Description:We illustrate the case of a 68-year-old male who presented with coma, ocular gaze palsy, and severe bradycardia from bilateral thalamic nuclei and midbrain infarction, as described as an artery of Percheron infarction. The patient recovered neurologically under conservative treatment with a residual vertical diplopia from downward gaze palsy. He underwent cardiac pacer implantation for severe bradycardia at the end of his admission. The thalamic pathway associated with cardiac rhythm, especially the zona inserta, is discussed. Publications related to the artery of Percheron are reviewed.Conclusion:Coma and ocular gaze palsy are the most common presentations following thalamic and midbrain ischemia from artery of Percheron infarction. To our knowledge, only a single case of artery of Percheron infarction with severe bradycardia has been reported in the past. Our case attested the role of thalamic nuclei controlling cardiac rhythm.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Artery of Percheron infarction results in severe bradycardia: A case report

Asavaaree¹,

Doyle²,

Smithason³

2018

Surg Neurol Int

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“…Lowered blood pressure and lack of consciousness arise following the activation of the zona incerta and the ventrolateral diencephalon due to the blockage of sympathetic efferent input from the posterior thalamus, which receives an afferent from the anterior insular cortex [7,8]. Typically, the zona incerta is supplied by the left and right PCA since it is part of the thalamic nuclei; however, in some individuals, it can be supplied by an uncommon anatomic variant-AOP, which lacks anastomotic connections [9]. The reticular activating system (RAS) is a network of neurons located in the brain stem with projections to the hypothalamus anteriorly and thalamus posteriorly.…”

Section: Discussionmentioning

confidence: 99%

A Case of Diagnostic Difficulty: Transient Loss of Consciousness in Artery of Percheron Infarct

Sharma

Bande

Matta

2021

Cureus

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The artery of Percheron (AOP) is a rare anatomical variant of the paramedian thalamic vessels in 7-10% of the general population. An AOP infarct can present with rare clinical manifestations like transient loss of consciousness (LOC) and lethargy, as was seen in the patient whose case is discussed in this report, due to the plethora of regulatory inputs and outputs by the thalamus, which cannot be compensated for because of the absence of anastomotic connections. The AOP supplies the reticular activating system (RAS), which regulates consciousness. Ischemia to this area from an AOP infarct can result in the transient LOC, which our patient experienced. The AOP is a small vessel that is often missed on a CT angiogram (CTA) alone due to low resolution. As a result, it is imperative that clinicians utilize MRI to diagnose AOP infarcts in patients who present with symptoms that raise concerns for decreased bilateral thalamic function and transient LOC.

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“…A ocorrência de infarto talâmico bilateral pela oclusão da artéria de Percheron (AdP) é um fenômeno raro e representa cerca de 0.1 -0.3% de todos os acidentes vasculares cerebrais isquêmicos (AVCi) (Qian, Wu, Peng, & Liu, 2017). Somado a isso, a falta de sinais clínicos clássicos de AVCi torna o diagnóstico no ambiente de emergência desafiador (Ranasinghe, Boo, & Adcock, 2019).…”

Section: Discussionunclassified

Infarto talâmico bilateral: relato de 2 casos

Machado

Costa

Júnior

et al. 2020

RSD

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Esse trabalho teve como objetivo relatar dois casos de infarto talâmico bilateral, sendo um com acometimento mesencefálico. Foi utilizado o CARE checklist para o relato dos dois casos. No primeiro (75 anos), história de hipertensão arterial sistêmica, apresentou súbito rebaixamento do nível de consciência, escala de coma de glasgow (ECG) 9, tetraparesia, paralisia do III nervo craniano e ptose palpebral à esquerda, anisocoria (E>D), ausência de reflexo fotomotor e estrabismo divergente. Tomografia computadorizada (TC) evidenciou hipodensidade em região mesencefálica mediana e região talâmica paramediana bilateral. O tratamento foi conservador, com evolução para melhora do estado geral, mas com paralisia completa do III nervo craniano à esquerda. No segundo (38 anos), previamente hígida, apresentou súbito rebaixamento do nível de consciência, disartria e ECG 13. TC negativa, enquanto a ressonância magnética apresentou hipersinal nas sequências T2/FLAIR, acometendo a região paramediana de ambos os tálamos com predomínio à direita. Realizado tratamento conservador, evoluindo para melhora significativa do quadro neurológico. Embora ocorra apresentação típica com distúrbios de estado mental e motricidade ocular, alterações em TC podem não ser observadas, reforçando a necessidade de atenção à clínica súbita apresentada pelo paciente, para que se realizem novos exames de neuroimagem. Importa-se, portanto, relatar estes casos para o rápido diagnóstico e tratamento adequados para melhor prognóstico do paciente.

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Bilateral paramedian thalamic and midbrain infarction due to occlusion of the artery of percheron in an elderly male: a case report

Cited by 6 publications

References 7 publications

Artery of Percheron infarction results in severe bradycardia: A case report

Artery of Percheron infarction results in severe bradycardia: A case report

A Case of Diagnostic Difficulty: Transient Loss of Consciousness in Artery of Percheron Infarct

Infarto talâmico bilateral: relato de 2 casos

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