Decreased consciousness: bilateral thalamic infarction and its relation to the artery of Percheron

Turner, J.; Richardson, Tejal; Kane, Ingrid; Vundavalli, Sriram

doi:10.1136/bcr-2013-201848

Cited by 10 publications

(17 citation statements)

References 13 publications

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“…Transthoracic echocardiogram was negative for patent foramen ovale related stroke [ 28 , 39 , 40 ]. The etiological study had some weaknesses: bubble contrast echocardiography and contrast transcranial Doppler were not performed, and transesophageal echocardiography (the “golden diagnostic method”) was not available.…”

Section: Discussionmentioning

confidence: 99%

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Uncommon Association of Two Anatomical Variants of Cerebral Circulation: A Fetal-Type Posterior Cerebral Artery and Inferred Artery of Percheron, Complicated with Paramedian Thalamomesencephalic Stroke—Case Presentation and Literature Review

Anghelescu

2018

Case Reports in Neurological Medicine

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Background The unilateral fetal variant of the posterior cerebral artery (FPCA) is characterized by the congenital absence of the P1 arterial segment. The artery of Percheron (AOP) is an uncommon vascular variant, in which a single dominant thalamoperforating arterial trunk arises from one P1 segment, bifurcates, and provides bilateral supply to the paramedian thalami and rostral midbrain. Case Presentation This is a retrospective case study of a 37-year-old man with multiple lifestyle risk factors (chronic marijuana and tobacco abuse), who suffered a thalamomesencephalic stroke, rapidly worsening to comatose state. After restoration of consciousness, he clinically manifested with left paramedian midbrain syndrome. Imaging demonstrated an asymmetric paramedian thalamic infarction with mesencephalon extension, patency of the basilar, vertebral arteries, and left PCA and right-sided FPCA, respectively. Left-sided thalamoperforating arterioles were not differentiated; AOP was inferred. Neither evident clinical source of embolus nor prothrombotic states were found. Mobile cardiac telemetry and transesophageal echocardiography were not available. The diagnosis was established too late for thrombolytic treatment. Anticoagulation was indicated during the acute and subacute stages, followed by low dose of antiplatelet. Discussion This uncommon cerebrovascular configuration (FPCA+AOP) might be the fourth case described in the literature. Sustained rehabilitation and abstinence from tobacco and cannabis led to favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Cannabis-related stroke is not a myth, and cannabis consumption should be considered a risk factor for inducing ischemic stroke [ 40 , 47 – 49 ]. The case reported a chronic marijuana and tobacco abuse, with a clear time-event related stroke after cannabis smoking (a few hours preceding the cerebral drama).…”

Section: Discussionmentioning

confidence: 99%

Uncommon Association of Two Anatomical Variants of Cerebral Circulation: A Fetal-Type Posterior Cerebral Artery and Inferred Artery of Percheron, Complicated with Paramedian Thalamomesencephalic Stroke—Case Presentation and Literature Review

Anghelescu

2018

Case Reports in Neurological Medicine

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“…The fluctuating nature of this clinical syndrome is well described20 21 and may lead to the diagnosis of stroke being overlooked in favour of other differential diagnoses 22. This may ultimately delay diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

Fluctuating drowsiness following cardiac catheterisation: artery of Percheron ischaemic stroke causing bilateral thalamic infarcts

Hammersley¹,

Arora

Dissanayake

et al. 2017

BMJ Case Reports

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An 81-year-old man underwent cardiac catheterisation to investigate breathlessness and left ventricular impairment of unknown cause. He had unobstructed coronary arteries. Immediately following the procedure, he became suddenly unresponsive with vertical gaze palsy, anisocoria and bilateral upgoing plantar responses. He made a rapid recovery to his premorbid state 25 min later with no residual focal neurological signs. He then had multiple unresponsive episodes, interspaced with complete resolution of symptoms and neurological signs. MRI of the brain identified bilateral medial thalamic infarcts and midbrain infarcts, consistent with an artery of Percheron territory infarction. By the time the diagnosis was reached, the thrombolysis window had elapsed. The unresponsive episodes diminished with time and the patient was discharged to inpatient rehabilitation. At 6-month review after the episode, the patient has a degree of progressive cognitive impairment.

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“…Sudden onset of altered eye movements with partial/complete limitation of vertical gaze, loss of convergence, bilateral internuclear ophthalmoplegia, pseudopalsy of the abducens nerve, and intolerance to light are the characteristics; pupils are frequently abnormal, and pupil size varies depending on the involvement of the Edinger–Westphal nucleus or oculomotor fascicles, descending sympathetic fibers, or some combination of these structures 11–13. Dysarthria, altered consciousness, and motor paresis should alert the clinician to the possibility of ischemia of posterior circulation territory, including the BA.…”

Section: Discussionmentioning

confidence: 99%

Complex neurological symptoms in bilateral thalamic stroke due to Percheron artery occlusion

Caruso¹,

Manganotti²,

Moretti³

2016

VHRM

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The artery of Percheron is a rare anatomical variant where a single thalamic perforating artery arises from the proximal posterior cerebral artery (P1 segment) between the basilar artery and the posterior communicating artery and supplies the rostral mesencephalon and both paramedian territories of the thalami. Almost one-third of human brains present this variant. Occlusion of the artery of Percheron mostly results in a bilateral medial thalamic infarction, which usually manifests with altered consciousness (including coma), vertical gaze paresis, and cognitive disturbance. The presentation is similar to the “top of the basilar syndrome”, and early recognition should be prompted. We describe the case of a young female with this vessel variant who experienced a bilateral thalamic stroke. Magnetic resonance angiography demonstrated bilateral thalamic infarcts and a truncated artery of Percheron. Occlusion of the vessel was presumably due to embolism from a patent foramen ovale. Thrombolysis was performed, with incomplete symptom remission, cognitive impairment, and persistence of speech disorders. Early recognition and treatment of posterior circulation strokes is mandatory, and further investigation for underlying stroke etiologies is needed.

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Decreased consciousness: bilateral thalamic infarction and its relation to the artery of Percheron

Cited by 10 publications

References 13 publications

Uncommon Association of Two Anatomical Variants of Cerebral Circulation: A Fetal-Type Posterior Cerebral Artery and Inferred Artery of Percheron, Complicated with Paramedian Thalamomesencephalic Stroke—Case Presentation and Literature Review

Uncommon Association of Two Anatomical Variants of Cerebral Circulation: A Fetal-Type Posterior Cerebral Artery and Inferred Artery of Percheron, Complicated with Paramedian Thalamomesencephalic Stroke—Case Presentation and Literature Review

Fluctuating drowsiness following cardiac catheterisation: artery of Percheron ischaemic stroke causing bilateral thalamic infarcts

Complex neurological symptoms in bilateral thalamic stroke due to Percheron artery occlusion

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