Thalamic Ischemic Stroke as a Result of the Occlusion of the Artery of Persheron
https://doi.org/10.20862/0042-4676-2020-101-2-121-125
Abstract
The artery of Percheron originates from the right or left posterior cerebral artery and is one of the options for normal blood supply to the paramedian portions of the thalamus. Stroke in this area has specific MRI changes, the most informative ones in diffusion-weighted imaging mode. With the involvement of the midbrain, its pial surface can display an additional pathognomonic V-shaped sign in 67%. The clinical manifestations are non-specific. In some cases, there is a triad of symptoms, which is distinguished into paramedian thalamic syndrome (vertical gaze palsy, neuropsychological disorders, and depressed level of consciousness up to coma). The symptoms of a midbrain lesion as oculomotor nerve group diseases, contralateral hemiparesis, hemiataxia or hemianesthesia, in combination with a triad, develop a thalamopeduncular or mesencephalon thalamic syndrome. The paper presents a clinical case of a 59-year-old man who was hospitalized with acute unconsciousness, a Glasgow coma scale of 13 scores, and disorientation. A neurological examination revealed vertical gaze palsy and upper limb ataxia. Brain MRI revealed characteristic bithalamic paramedian stroke. After completing the treatment, the patient was discharged showing incomplete clinical recovery.
About the Authors
A. V. Titov
City Clinical Hospital № 13
Russian Federation
Russian Federation
Anton V. Titov, Anesthesiologist
ul. Velozavodskaya, 1/1, Moscow, 115280
O. E. Mozgovaya
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Ol'ga E. Mozgovaya, Student
ul. Trubetskaya, 8, stroenie 2, Moscow, 119991
References
1. Cassourret G., Prunet B., Sbardella F., Bordes J., Maurin O., Boret H. Ischemic stroke of the artery of Percheron with normal initial MRI: a case report. Case Rep. Med. 2010; 2010: 425734. DOI: 10.1155/2010/425734
2. Lazzaro N.A., Wright B., Castillo M., Fischbein N.J., Glastonbury C.M., Hildenbrand P.G. et al. Artery of Percheron infarction: imaging patterns and clinical spectrum. Am. J. Neuroradiol. 2010; 31 (7): 1283–9. DOI: 10.3174/ajnr.A2044
3. Kraft P., Waschbisch A., Wendel F., Muellges W., Classen J. Why it’s important to know Percheron’s artery: solitary carotid stenosis as a unique cause of anterior, posterior and bithalamic ischemia. J. Neurol. 2009; 256 (9): 1558–60. DOI: 10.1007/s00415-009-5140-4
4. Amin O.S., Shwani S.S., Zangana H.M., Hussein E.M., Ameen N.A. Review bilateral infarction of paramedian thalami: a report of two cases of artery of Percheron occlusion and review of the literature. BMJ Case Rep. 2011; 2011. DOI: 10.1136/bcr.09.2010.3304
5. Carrera E., Michel P., Bogousslavsky J. Anteromedian, central, and posterolateral infarcts of the thalamus: three variant types. Stroke. 2004; 35 (12): 2826–31. DOI: 10.1161/01.STR.0000147039.49252.2f
6. Fursova L.A., Naumenko D.V. Thalamic infarcts in the pool of the artery of Persheron: clinical features and diagnosis. International Neurological Journal. 2013; 1 (55): 25-33 (in Russ.).
7. Shea Y.F., Lin O.Y., Chang R.S., Luk J.K.. Artery of Percheron infarction. Hong Kong Med. 2012; 18 (5): 446–e1.
8. Harharpreet K., Gurinder M., Vikas Sh., Kunwar P.S., Kawlinder G., Raminder P., Harsehaj S. Artery of Percheron infarct: a case report. Int. J. Res. Med. Sci. 2018; 6 (3): 1035–9. DOI: 10.18203/2320-6012.ijrms20180635 Percheron G. Arteries of the human thalamus. II. Arteries and paramedian thalamic territory of the communicating basilar artery. Rev. Neurol. (Paris). 1976; 132 (5): 309—24.
9. Rodriguez E.G., Lee J.A. Bilateral thalamic infarcts due to occlusion of the artery of Percheron and discussion of the differential diagnosis of bilateral thalamic lesions. J. Radiol. Case Rep. 2013; 7 (7): 7–14. DOI: 10.3941/jrcr.v7i7.961
10. Jimenez Caballero P.E. Bilateral paramedian thalamic artery infarcts: report of 10 cases. J. Stroke Cerebrovasc. Dis. 2010; 19 (4): 283–9. DOI: 10.1016/j.jstrokecerebrovasdis.2009.07.003
11. Nalbantoglu M., Ozturk-Tan O., Bayazıt N., Tayfun F. Percheron artery infarction in the differential diagnosis of acute confusional state with normal initial brain MRI. Acta Neurol. Belg. 2016; 116 (1): 73–5. DOI: 10.1007/s13760-015-0505-1
12. Sandvig A., Lundberg S., Neuwirth J. Artery of Percheron infarction: a case report. J. Med. Case Rep. 2017; 11: 221. DOI: 10.1186/s13256-017-1375-3
13. Xu Z., Sun L., Duan Y., Zhang J., Zhang M., Cai X. Assessment of Percheron infarction in images and clinical findings. J. Neurol. Sci. 2017; 383: 87–92. DOI: 10.1016/j.jns.2017.10.033
14. Krampla W., Schmidbauer B., Hruby W. Ischaemic stroke of the artery of Percheron (2007: 10b). Eur. Radiol. 2008; 18 (1): 192–4. DOI: 10.1007/s00330-007-0615-0
15. Chatterjee S., Thomas B., Kesavadas C., Kapilamoorthy T.R. Susceptibility-weighted imaging in differentiating bilateral medial thalamic venous and arterial infarcts. Neurol. India. 2010; 58 (4): 615–7. DOI: 10.4103/0028-3886.68670
16. Kostanian V., Cramer S. Artery of Percheron thrombolysis. CAJNR Am. J. Neuroradiol. 2007; 28 (5): 870–1.
Review
For citations:
Titov A.V., Mozgovaya O.E. Thalamic Ischemic Stroke as a Result of the Occlusion of the Artery of Persheron. Journal of radiology and nuclear medicine. 2020;101(2):121-125. (In Russ.) https://doi.org/10.20862/0042-4676-2020-101-2-121-125
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