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Neurocritical Care

, Volume 20, Issue 3, pp 494–501 | Cite as

Artery of Percheron Infarction as an Unusual Cause of Coma: Three Cases and Literature Review

  • Nathalie Zappella
  • Sybille Merceron
  • Chantal Nifle
  • Julia Hilly-Ginoux
  • Fabrice Bruneel
  • Gilles Troché
  • Yves-Sebastien Cordoliani
  • Jean-Pierre Bedos
  • Fernando Pico
  • Stephane Legriel
Practical Pearl

Abstract

Objective

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.

Methods

Description of three cases and literature review based on a 1973–2013 PubMed search.

Results

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.

Conclusions

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.

Keywords

All cerebrovascular disease/Stroke Coma 

Notes

Acknowledgments

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.

Supplementary material

12028_2014_9962_MOESM1_ESM.docx (78 kb)
Supplementary material 1 (DOCX 77 kb)

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Nathalie Zappella
    • 1
  • Sybille Merceron
    • 1
  • Chantal Nifle
    • 2
  • Julia Hilly-Ginoux
    • 1
  • Fabrice Bruneel
    • 1
  • Gilles Troché
    • 1
  • Yves-Sebastien Cordoliani
    • 3
  • Jean-Pierre Bedos
    • 1
  • Fernando Pico
    • 2
  • Stephane Legriel
    • 1
  1. 1.Intensive Care UnitCentre Hospitalier de Versailles—Site André MignotLe ChesnayFrance
  2. 2.Neurology Department and Stroke CenterCentre Hospitalier de Versailles—Site André MignotLe ChesnayFrance
  3. 3.Radiology DepartmentHôpital privé de Parly IILe ChesnayFrance

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