Artery of Percheron Infarction as an Unusual Cause of Coma: Three Cases and Literature Review
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Stroke due to occlusion of the artery of Percheron (AOP), an uncommon anatomic variant supplying the bilateral medial thalami, may raise diagnostic challenges and cause life-threatening symptoms. Our objective here was to detail the features and outcomes in three patients who required intensive care unit (ICU) admission and to review the relevant literature.
Description of three cases and literature review based on a 1973–2013 PubMed search.
Three patients were admitted to our ICU with sudden-onset coma and respiratory and cardiovascular dysfunctions requiring endotracheal mechanical ventilation. Focal neurological deficits, ophthalmological signs (abnormal light reflexes and/or ocular motility and/or ptosis), and neuropsychological abnormalities were variably combined. Initial CT scan was normal. Cerebral MRI demonstrated bilateral paramedian thalamic infarction, with extension to the cerebral peduncles in two patients. Consciousness improved rapidly and time to extubation was 1–4 days. All three patients were discharged alive from the hospital and two had good 1-year functional outcomes. Similar clinical features and outcomes were recorded in the 117 patients identified in the literature, of whom ten required ICU admission.
Bilateral paramedian thalamic stroke due to AOP occlusion can be life threatening. The early diagnosis relies on MRI with magnetic resonance angiography. Recovery of consciousness is usually rapid and mortality is low, warranting full-code ICU management.
KeywordsAll cerebrovascular disease/Stroke Coma
We thank A. Wolfe MD for helping to prepare the manuscript. We received no funds for this study.
Conflict of interest
The authors have declared that no competing interests exist.
Disclosures of Authors Financial Relationships Relevant to the Study
Nathalie Zappella: reports no disclosures, Sybille Merceron: reports no disclosures, Chantal Nifle: reports no disclosures, Julia Hilly-Ginoux: reports no disclosures, Fabrice Bruneel: reports no disclosures, Gilles Troché: reports no disclosures, Yves-Sebastien Cordoliani: reports no disclosures, Jean-Pierre Bedos: reports no disclosures, Fernando Pico: reports no disclosures, Stephane Legriel: reports no disclosures.
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