Abstract
IntroductionBilateral thalamic infarcts are rare presentations of stroke. They are the result of a complex combination of risk factors and a predisposing vessel distribution. The artery of Percheron, characterized by a single arterial trunk that irrigates both paramedian thalamic regions, can be occluded as a result of embolic diseases leading to bilateral paramedian thalamic infarcts. Clinical and image findings of this uncommon form of posterior circulation infarct are presented along with their anatomic and pathophysiologic correlates.Case presentationA 27-year-old Mexican man with no relevant medical history was admitted to hospital after he was found deeply stuporous. On admission, an urgent neuroimaging protocol for stroke, including magnetic resonance imaging and magnetic resonance imaging angiography, was performed. The scans revealed symmetric bilateral hyperintense paramedian thalamic lesions consistent with acute ischemic events. The posterior circulation was patent including the tip of the basilar artery and both posterior cerebral arteries, making the case compatible with occlusion of the artery of Percheron. Further evaluation with an aim to define the etiology revealed a patent foramen ovale as the cause of embolism.ConclusionBilateral thalamic infarcts are unusual presentations of posterior circulation stroke; once they are diagnosed by an adequate neuroimaging protocol, a further evaluation to define the cause is necessary. Cardioembolism should always be considered in relatively young patients. A complete evaluation should be conducted by an interdisciplinary team including neurologists, cardiologists and neurosurgeons.
Highlights
Bilateral thalamic infarcts are rare presentations of stroke
The artery of Percheron, characterized by a single arterial trunk that irrigates both paramedian thalamic regions, can be occluded as a result of embolic diseases leading to bilateral paramedian thalamic infarcts
Introduction infarcts restricted to the thalamus were reported for the first time more than 100 years ago by Dejerine and Roussy [1], they remain a rare presentation of stroke and account for only 11% of all vertebrobasilar infarcts [2]
Summary
Infarcts restricted to the thalamus were reported for the first time more than 100 years ago by Dejerine and Roussy [1], they remain a rare presentation of stroke and account for only 11% of all vertebrobasilar infarcts [2]. The paramedian thalamic territory is the median part of the thalamus including the intralaminar nuclei and most of the dorsomedian nucleus. It is supplied by the paramedian arteries, usually emerging directly from the first segment of posterior cerebral arteries (P1 segment) on both sides; in one-third of human brains, these originate from a single pedicle (Figure 1) known as the type B artery of Percheron [11,12]. Case presentation A 27-year-old Mexican man was admitted to our hospital after he was found in a deep stupor He had no previous history of disease and did not smoke or take alcohol or illicit drugs. No other embolic events have occurred while there is a pending procedure of percutaneous closure using an Amplatzer device
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