open access

Vol 50, No 3 (2016)
Case reports
Submitted: 2015-12-11
Get Citation

Midbrain and bilateral paramedian thalamic stroke due to artery of Percheron occlusion

Magdalena Restel, Ałła Graban, Grzegorz Witkowski, Danuta Ryglewicz, Halina Sienkiewicz-Jarosz
DOI: 10.1016/j.pjnns.2016.01.008
·
Neurol Neurochir Pol 2016;50(3):180-184.

open access

Vol 50, No 3 (2016)
Case reports
Submitted: 2015-12-11

Abstract

Introduction

Bilateral thalamic strokes are rare manifestations of posterior circulation infarcts. Usually the etiology is cardioembolic or small vessel disease combined with individual anatomical predisposition. The symptoms include a variety of neurological deficits depending on thalamic structure involvement, such as paresthesias or numbness, hemiparesis with increased reflexes and Babinski sign, third cranial nerve palsy, speech and cognition disturbance, memory impairment and stupor. Neuroimaging usually reveals ischemic loci in adequate thalamic nuclei.

Case presentation

We report a case of 61-year-old man, active smoker (25/per day, 50 pack-years) with untreated hypertension who presented at admission consciousness impairment (Glasgow Coma Scale score 9 points), left pupil dilatation without reaction to light, left eye deviation downwards and outwards, vertical gaze paralysis and left-sided hemiplegia. Initial brain computed tomography (CT) was normal. Brain magnetic resonance with diffusion weighted imaging and fluid attenuation inversion recovery sequences (MR DWI/FLAIR) performed on admission showed ischemic changes in bilateral thalami, which were confirmed in routine MRI. Thrombosis of basilar artery and cerebral venous was excluded in CT angiography. Further diagnostic assessment revealed hyperlipidemia, paroxysmal atrial fibrillation and renal cancer with hepatic metastases.

Conclusion

Bilateral thalamic stroke due to artery of Percheron occlusion is a rare presentation of stroke, which can be overlooked in routine CT scan. If diagnosed, it requires further evaluation for stroke risk factors, especially cardiovascular disorders associated with increased embolic risk.

Abstract

Introduction

Bilateral thalamic strokes are rare manifestations of posterior circulation infarcts. Usually the etiology is cardioembolic or small vessel disease combined with individual anatomical predisposition. The symptoms include a variety of neurological deficits depending on thalamic structure involvement, such as paresthesias or numbness, hemiparesis with increased reflexes and Babinski sign, third cranial nerve palsy, speech and cognition disturbance, memory impairment and stupor. Neuroimaging usually reveals ischemic loci in adequate thalamic nuclei.

Case presentation

We report a case of 61-year-old man, active smoker (25/per day, 50 pack-years) with untreated hypertension who presented at admission consciousness impairment (Glasgow Coma Scale score 9 points), left pupil dilatation without reaction to light, left eye deviation downwards and outwards, vertical gaze paralysis and left-sided hemiplegia. Initial brain computed tomography (CT) was normal. Brain magnetic resonance with diffusion weighted imaging and fluid attenuation inversion recovery sequences (MR DWI/FLAIR) performed on admission showed ischemic changes in bilateral thalami, which were confirmed in routine MRI. Thrombosis of basilar artery and cerebral venous was excluded in CT angiography. Further diagnostic assessment revealed hyperlipidemia, paroxysmal atrial fibrillation and renal cancer with hepatic metastases.

Conclusion

Bilateral thalamic stroke due to artery of Percheron occlusion is a rare presentation of stroke, which can be overlooked in routine CT scan. If diagnosed, it requires further evaluation for stroke risk factors, especially cardiovascular disorders associated with increased embolic risk.

Get Citation

Keywords

Thalamic stroke, Artery of Percheron occlusion, Consciousness disturbance

About this article
Title

Midbrain and bilateral paramedian thalamic stroke due to artery of Percheron occlusion

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 50, No 3 (2016)

Pages

180-184

DOI

10.1016/j.pjnns.2016.01.008

Bibliographic record

Neurol Neurochir Pol 2016;50(3):180-184.

Keywords

Thalamic stroke
Artery of Percheron occlusion
Consciousness disturbance

Authors

Magdalena Restel
Ałła Graban
Grzegorz Witkowski
Danuta Ryglewicz
Halina Sienkiewicz-Jarosz

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl