Abstract
Bithalamic infarction resulting from occlusion of the artery of Percheron after cervical spine surgery is a rare pathological entity. Diagnosis and early detection are challenging. Prompt management may help to improve the outcome. We present a case of a 39-year-old male patient, smoker, diagnosed with multiple cervical disc herniations, who underwent Anterior Cervical Discectomy and Fusion (ACDF) for C3-C4, C4-C5, and C5-C6. During the 2-hour and 50-minute surgery, the patient was lying supine with his neck hyperextended. The intraoperative procedure was uneventful. During surgery, blood pressure ranged around 110 mmHg∖50 mmHg. At the end of surgery, the patient's recovery from general anesthesia was normal with no delaying or complication; on next the day, patient developed a sudden loss of consciousness. Urgent brain computed tomography (CT) was normal; two days later, follow-up CT and CT Angiography (CTA) revealed bilateral thalamic infarction with right vertebral artery occlusion from its origin. Intraoperative surgical manipulation, hypotensive anesthesia, and prolonged neck hyperextension might have contributed to stroke in this patient. ACDF carries a potential risk for posterior circulation stroke. Artery of Percheron infarction should be considered in the differential diagnosis of patients developing a sudden loss of consciousness after ACDF. Vertebral artery thrombosis should be taken into account as an important possible cause of embolism.
Highlights
Anterior cervical discectomy with fusion (ACDF) is an established intervention for cervical degenerative disease [1]
The artery of Percheron (AOP) is a rare anatomic variation in the posterior circulation of the brain in which a single arterial trunk arises from the first part of the posterior cerebral artery (PCA) and supplies the medial region of both thalami
We report a case of bithalamic infarction due to embolic occlusion of the artery of Percheron as a consequence of vertebral artery (VA) thrombosis
Summary
Anterior cervical discectomy with fusion (ACDF) is an established intervention for cervical degenerative disease [1]. ACDF is a relatively safe procedure with a very low morbidity and mortality rate [2]. This procedure may be associated with serious postoperative complications like strokes. One of the vascular variations of the brain where a cerebral blood vessel supplies structures on both sides is the artery of Percheron. The artery of Percheron (AOP) is a rare anatomic variation in the posterior circulation of the brain in which a single arterial trunk arises from the first part of the posterior cerebral artery (PCA) and supplies the medial region of both thalami. We report a case of bithalamic infarction due to embolic occlusion of the artery of Percheron as a consequence of vertebral artery (VA) thrombosis
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