Vertical one-and-a-half syndrome in a patient with pecheron artery ischemia: A case report

Gonçalves, Daniel Buzaglo; Barreira, Raphael Palomo; Torres, Thomas Zurga Markus; Correa, Beatriz Medeiros; Rossette, Vanessa Moraes; Marques, Thiago da Cruz; Costa, Fernando Pierini; Dutra, Bruna Guimarães; Júnior, Euldes Mendes; Moreira, Álvaro Rivelli; Santos, Júlio César Claudino dos

doi:10.1016/j.radcr.2021.09.028

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Acute ischemia of AOP is uncommon, which accounted for 0.1–0.3% of all cerebral infarction [ 13 , 14 ]. However, this is likely a conservative estimate due to the insufficient knowledge of it and limitations in the inclusion criteria [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Acute percheron infarction: a precision learning

Zhang

Wang²,

Chen

et al. 2022

BMC Neurol

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Background So far, the diagnosis of acute artery of percheron (AOP) infarction is uncommon. In this study, patients with acute AOP infarction were studied to explore the relationship of imaging findings, clinical manifestations and prognosis of acute AOP infarction. Materials A total of 23 patients with acute AOP infarction in our institution from 2014 to 2019 were reviewed retrospectively. All cases were evaluated by computed tomography (CT) and magnetic resonance imaging (MRI). The modified Rankin scale (MRS), blood examination, electrocardiogram and transthoracic echocardiography were used for detailed clinical and prognostic evaluation. All standard risk factors for these patients were recorded. The MRS scores were performed 90 days after discharge. Results Four different types of acute AOP infarction were identified: (a) bilateral paramedian thalamic infarction (BPTI, 52%); (b) bilateral paramedian thalamic with rostral midbrain infarction (BPTRMI, 30%), (c) bilateral paramedian and anterior thalamic infarction (BPATI, 13%), and (d) bilateral paramedian thalamic with red nuclei infarction (BPTRNI, 4%). These patients had consciousness disorder, memory dysfunctions, vertical gaze paresis and mesencephalothalamic syndrome. The 65% of patients with BPTI and BPATI experienced relatively good functional recovery and could carry out daily life activities (MRS score ≤ 2). However, patients with BPTRMI may have an unfavorable outcome. Conclusions Although the clinical features are variable, DWI or ADC map can improve the diagnosis of acute AOP infarction patterns. Acute AOP occlusion requires immediate diagnosis and treatment to obtain more favorable outcome and avoid additional unnecessary procedures.

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Section: Discussionmentioning

confidence: 99%

Acute percheron infarction: a precision learning

Zhang

Wang²,

Chen

et al. 2022

BMC Neurol

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“…La arteria de Percherón se origina de un solo pedículo, y puede expresar un síndrome clínico complejo, siendo el origen de 0.1 a 6% de todos los infartos cerebrales. [1][2][3] La arteria paramediana deriva del segmento P1 proximal de la arteria cerebral posterior, e irriga el tálamo ventral medial, el hipotálamo, así como la unión subtálamo mesencéfalica, parte superior del tronco encefálico, que abarca los núcleos interpedunculares, la decusación de los pedúnculos cerebelares superiores, porción anterior de la sustancia gris periacueductal, parte medial del núcleo rojo, núcleo del tercer y cuarto par craneal. [4][5] En términos anatómicos, se trata de un tronco común que emerge desde la arteria cerebral posterior entre la arteria basilar y la arteria comunicante posterior, irrigando ambos territorios paramediales del tálamo y territorios de la región mesencéfalica rostral.…”

Section: Antecedentesunclassified

Síndrome de la arteria de Percherón, reporte de caso clínico y revisión de la literatura

Vallejo

Anzures-Gómez²,

Camacho-Becerra³

et al. 2022

Arch Neurocien

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La relevancia de este caso clínico se sustenta en que el diagnóstico oportuno de enfermedad vascular cerebral se centra en delimitar el daño una vez diagnosticado procurando en todo momento las zonas de oligohemia y penumbra que si bien es un problema de salud pública entre mayor accesibilidad a información sombre manifestaciones clínicas complejas con abordaje de exploración neurológica se podrán brindar más herramientas para los colegas mejorando cada vez más el abordaje terapéutico. Se reporta un caso clínico inusual en cuanto a ictus al igual que se realiza una revisión de la literatura retomando que la arteria de Percherón fue descrita por primera vez en 1973 por Gérard Percherón como una variante anatómica tálamo perforante no tan infrecuente, presente en hasta el 11 al 33% de la población, regularmente subdiagnósticada en nuestro medio, recordando que la irrigación de mesencéfalo anterior e inferior y tálamo es dada por la arteria carótida interna mientras que los territorios mediales, laterales y posteriores son irrigados por el sistema vertebrobasilar. Este síndrome talamopeduncular debido a la oclusión de la arteria de Percherón se expresa como un infarto talámico bilateral medial que generalmente cursa con la triada de alteración del estado del despierto en varios niveles incluso coma, súbita paresia parcial o total de la mirada vertical, afectación de la cognición memoria.

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“…Symptoms of one and a half syndrome are related to visual impairment, and there are no specific symptoms attributed solely to one and a half syndrome; symptoms depend on the underlying cause of the syndrome. 3,14,15 The primary management of one and a half…”

Section: Introductionmentioning

confidence: 99%

One and a Half Syndrome and Internuclear Ophthalmoplegia as Neuro-Ophthalmological Manifestations in Patients with Brainstem Stroke: A Case Series

Mahardhika Maghfirani Sadewa,

Celine Cornelia,

Maula Nuruddin Gaharu

et al. 2024

Bioscmed

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Background: Brainstem stroke syndrome accounts for 10-15% of all types of strokes, which may result in relatively rare neuroophthalmological manifestations. The aim of this case report is to report findings of one and a half syndrome (OAHS) and internuclear ophthalmoplegia in a patient with brainstem stroke. Case presentation: First case, female, 56 years old, came with sudden weakness on the right side of the body. One and a half syndrome was found, namely when asked to glance to the left, conjugate gaze palsy was obtained horizontally, and when asked to glance to the right, there was adduction inability of the left eye (ipsilateral). Right eye abduction was normal with present nystagmus. Paresis of right central CN. VII, XII was present, along with hemiparesis dextra (contralateral). Head CT scan shows hemorrhage in pons and intraventricular. Second case, female, 65 years old, came with a protruding mouth, vertigo, and sudden double vision Internuclear ophthalmoplegia was present, namely an adduction inability of the left eye (ipsilateral) when asked to glance to the right. Right eye abduction was normal with present nystagmus. no abnormalities were seen in the primary position and when asked to glance to the left. Paresis of right peripheral CN. VII, hemiparesis and right (contralateral) hemihypesthesia was present. MRI shows multiple chronic infarcts as well as subacute infarcts in bilateral parietal and pons. Conclusion: Clinical knowledge is necessary for topic determination, rehabilitation process and evaluation.

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Vertical one-and-a-half syndrome in a patient with pecheron artery ischemia: A case report

Cited by 4 publications

References 7 publications

Acute percheron infarction: a precision learning

Acute percheron infarction: a precision learning

Síndrome de la arteria de Percherón, reporte de caso clínico y revisión de la literatura

One and a Half Syndrome and Internuclear Ophthalmoplegia as Neuro-Ophthalmological Manifestations in Patients with Brainstem Stroke: A Case Series

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