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Thalamic infarct presenting as catastrophic life-threatening event in an older adult

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Abstract

An 84 year old woman with history of moderate Alzheimer’s disease, depression, and an anxiety disorder presented to our emergency room at Victoria Hospital, London, Ontario in an ‘unresponsive’ state. The patient was akinetic with mutism, and clonic perseveration induced in the upper limbs was evident while she was examined. Heart attack, massive stroke, or intracranial bleed were ruled out, and an electroencephalogram showed no epileptiform activity. Despite a normal CT, a magnetic resonance scan was ordered and showed bilateral acute paramedian thalamogeniculate infarction arising from occlusion of the artery of Percheron. Bilateral thalamic infarcts can cause sudden onset of akinetic mutism with clonic perseveration, which may be confused with coma and seizures due to life threatening conditions such as a massive stroke. Thorough clinical assessment and early use of MRI scanning will assist physicians with a more accurate diagnosis of older adults with this kind of presentation.

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Authors and Affiliations

  1. Department of Medicine, Acute Care of the Elderly Unit, University of Western Ontario, London, ON, Canada

    Malcolm Wells & Rebekah Jacques

  2. Internal Medicine Residency Program, University of Western Ontario, London, ON, Canada

    Malcolm Wells & Manuel Montero Odasso MD, PhD, AGSF

  3. Department of Pathology Residency Program, University of Western Ontario, London, ON, Canada

    Rebekah Jacques

  4. Division of Geriatric Medicine, Parkwood Hospital, University of Western Ontario, 801 commissioners Road East, Room A 280, London, ON, N6C 5J1, Canada

    Manuel Montero Odasso MD, PhD, AGSF

  5. Lawson Health Research Institute, University of Western Ontario, London, ON, Canada

    Manuel Montero Odasso MD, PhD, AGSF

  6. Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada

    Manuel Montero Odasso MD, PhD, AGSF

Authors
  1. Malcolm Wells
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  2. Rebekah Jacques
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  3. Manuel Montero Odasso MD, PhD, AGSF
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Corresponding author

Correspondence to Manuel Montero Odasso MD, PhD, AGSF.

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Wells, M., Jacques, R. & Odasso, M.M. Thalamic infarct presenting as catastrophic life-threatening event in an older adult. Aging Clin Exp Res 23, 320–322 (2011). https://doi.org/10.1007/BF03337758

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  • DOI: https://doi.org/10.1007/BF03337758

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