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Commentary
9 (
1
); 169-170
doi:
10.4103/jnrp.jnrp_435_17

Commentary

Department of Neurology, Memory Clinic, Dr. Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India

Address for correspondence: Dr. Vikas Dhikav, Department of Neurology, Dr. Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi - 110 001, India. E-mail: vikasdhikav@hotmail.com

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The occlusion of circulation of thalamus is a rare cause of acute ischemic stroke accounting for 10% of total stroke cases. Blood supply of thalamus is complex as it has a large number of feeding vessels.[12] There are significant variations in the blood supply of thalami arterial circulation and the supply is mainly by perforators from posterior cerebral artery and posterior communicating artery.[345] The artery of Percheron occlusion, which supplies thalamus, is responsible for only 1 out of 10–30 cases of all posterior cerebral circulation strokes.

Ischemic thalamic stroke is characterized by bilateral paramedian thalamic infarcts, with or without mesencephalic infarctions. Clinical presentation includes altered mental state, amnesia, and vertical gaze palsy. This type of ischemic strokes involving artery of Percheron (a branch of posterior cerebral circulation) is rarely reported. Quick diagnosis and early intervention can have a favorable outcome.

A French neurologist Percheron was the first to describe possible anatomic variations about 40 years back. Artery of Percheron arises from first part of posterior cerebral artery and supplies bilateral thalami,[4] the blockade of which can lead to thalamic infarcts. Occlusion of artery of Percheron by embolism results in bilateral paramedian thalami and rostral midbrain infarction in relatively symmetrical distribution. The presentation[678] can be variable with signs and symptoms ranging from motor deficits to behavioral and sensory alterations, but most commonly reported in available literature are vertical gaze paresis, memory impairment, confusion, and coma. Altered mental state, coma, or hypersomnolence, aphasia, dysarthria, amnesia, ocular movement disorders, and papillary abnormalities can occur. Hypersomnolence could be due to the fact that the structures (e.g., thalamus and midbrain) affected are associated with the regulation of alertness, consciousness, and sleep. The hypersomnolence could be attributed to bilateral lesions in the intralaminar nuclei which are part of the rostral extension of the midbrain reticular activity system.[9]

It is important for general/emergency care physicians and neurologists to be aware of artery of Percheron infarcts to properly diagnose and to initiate appropriate treatment and swift management of ischemic stroke symptoms. Hypersomnolence following bilateral thalamic infarction[10] needs prompt recognition and hence the timely diagnosis and management in the “window period” of 4.5 h is critical as successful thrombolysis has been reported in artery of Percheron infarction.[11]

REFERENCES

  1. , , , . Artery of Percheron infarction: A case report. J Med Case Rep. 2017;11:221.
    [Google Scholar]
  2. , , , , , . A rare case of ischemic stroke following occlusion of the artery of Percheron. JBR BTR. 2015;98:60.
    [Google Scholar]
  3. , , , , , . Contemporary therapeutic strategies for occlusion of the artery of Percheron: A review of the literature. J Neurointerv Surg. 2015;7:95-8.
    [Google Scholar]
  4. , , , , , . Bilateral infarction of paramedian thalami: A report of two cases of artery of Percheron occlusion and review of the literature. BMJ Case Rep 2011 2011:pii: bcr0920103304.
    [Google Scholar]
  5. , , , , , , . Parameters of diffusional kurtosis imaging for the diagnosis of acute cerebral infarction in different brain regions. Exp Ther Med. 2016;12:933-8.
    [Google Scholar]
  6. , , , , , , . Changes in structure and perfusion of grey matter tissues during recovery from ischaemic subcortical stroke: A longitudinal MRI study. Eur J Neurosci. 2017;46:2308-14.
    [Google Scholar]
  7. , , , , . Fluctuating drowsiness following cardiac catheterisation: Artery of Percheron ischaemic stroke causing bilateral thalamic infarcts. BMJ Case Rep 2017 2017:pii: bcr2016218035.
    [Google Scholar]
  8. , , , , . The impact of cortical lesions on thalamo-cortical network dynamics after acute ischaemic stroke: A combined experimental and theoretical study. PLoS Comput Biol. 2016;12:e1005048.
    [Google Scholar]
  9. , , . Artery of Percheron thrombolysis. AJNR Am J Neuroradiol. 2007;28:870-1.
    [Google Scholar]
  10. , , , , , , . Irreversible hypersomnolence after bilateral thalamic infarction. J Neurosci Rural Pract. 2018;9:167-8.
    [Google Scholar]
  11. , , , . Syndrome of downward gaze paralysis, amnesia and hypersomnolence. Postgrad Med J. 1989;65:840-2.
    [Google Scholar]

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