Artery of Percheron Infarction: A Characteristic Pattern of Ischemia and Variable Clinical Presentation: a literature review

: The Artery of Percheron (AOP) is an uncommon anatomic variant that provides arterial supply to the paramedian region of the thalami and bilaterally to the rostral part of the midbrain; it is a solitary arterial trunk that branches from a proximal segment of the posterior cerebral artery (PCA). Although AOP infarction results in a characteristic pattern of ischemia—namely bilateral paramedian thalamic infarct with or without midbrain involvement— it may cause diagnostic difficulties due to the variety of its clinical presentations and wide differentials, as well as its small diameter and the difficulty of obtaining visualization through diagnostic imaging. Early neuroimaging of AOP infarction and correct diagnosis are mandatory for early initiation of the appropriate treatment and better patient outcomes. In this study, we discuss imaging the patterns of AOP infarction, as well as its differentials and clinical presentation.

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Percheron Artery Ischemia: Case Report

10.5327/1516-3180.393 ◽

2021 ◽

Author(s):

Lília Tereza Diniz Nunes ◽

Flávia S. Silva ◽

Karyme G. Aota ◽

Maria Beatriz Miranda. S. B. de Assis ◽

João Fellipe B. Bento ◽

...

Keyword(s):

Case Report ◽

Cerebral Artery ◽

Cervical Dystonia ◽

Clinical Presentation ◽

Posterior Cerebral Artery ◽

Artery Of Percheron ◽

Thalamic Infarction ◽

Level Of Consciousness ◽

Artery Segment ◽

Thalamic Infarct

Context: The Artery of Percheron (AOP) is an uncommon anatomic vascular variation derivated from posterior cerebral artery segment P1, wich branchs to irrigate bilaterally the thalamus in it is paramedian portion. Amidst vascular cerebral events of the ischemic type, thalamic infarction occour in 11% of the cases. The typical clinical presentation is constituted by the triad: cogniyivebehavior comitente, oculomotors and consience disturbs. Case report: J.F.M.L, 51 years old, male, was found unconscious in his residence by SAMU and then interned in Stroke Room of HGP in 02/06/2020 with a lowered level of consciousness (Glasgow 8). The tests demonstrated a bilateral thalamic infarct due to Artery of Percheron Ischemia. In 02/09/2020 it evolved into a Glasgow 9 being extubated. The CT after 3 days demonstrated absence of bleeding and prophylatically initiated simvastatin, clexane, physiotherapy and phonoaudiology. In 02/15/2020, during physical exam, the pacient was lucid, presented behavior alterations, had left cervical dystonia and ataxia. The patient progressed well and was discharged the next day. Conclusions: The AOP, when occluded, results in bilateral paramedian thalamic and the rostral midbrain infarctions wich may cause diagnosis issues, mainly because of the vast specter of diferential diagnosis. In the presence of triad signals characteritic of bilateral thalamic infarction in CT, it must suspect the manifestation of such entity.

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Clinicomycological study of tinea infections in and around Pune

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20193236 ◽

2019 ◽

Vol 5 (3) ◽

pp. 598

Author(s):

Snehal Dhayagude ◽

Vidya Arjunwadkar ◽

Ravindranath Chavan ◽

Renu Bharadwaj ◽

Anju Kagal

Keyword(s):

Clinical Presentation ◽

Correct Diagnosis ◽

Conventional Technique ◽

Tinea Cruris ◽

Medical College ◽

Drug Eruptions ◽

Appropriate Treatment ◽

Hair Samples ◽

One Year ◽

Super Infection

Background: Tinea is a common fungal infection seen in the tropical and subtropical countries affecting the skin and its appendages. The presentation may vary from mild scaling to severe inflammation with bacterial super infection. It may be confused with other manifestation such as psoriasis, seborrhea, drug eruptions, eczema, and contact dermatitis. Hence correct diagnosis is necessary for appropriate treatment, which will reduce morbidity, discomfort and lessens possibility of transmissions. The aims and objectives were to determine clinicomycological profile of Tinea infections in patients attending dermatology OPD of B. J. Govt. Medical College and Sassoon General Hospital, Pune.Methods: Skin scrapings, nail clippings; hair samples from clinically suspected cases of tinea were collected. Identification of dermatophytes from these samples was done by conventional technique.Results: 119 clinically suspected cases of Tinea infections were processed over a period of one year. Out of these cases mixed infection of Tinea cruris with corporis was the predominant (27.73%) clinical presentation. Among all the samples, fungal filaments were seen by KOH mount in 48 (40.33%) whereas 35 (29.41%) samples were confirmed as dermatophytes by culture. Among these 35 isolates of dermatophytes 20 were T. rubrum, 7 isolates were T. tonsurans. 8 isolates were of T. mentagrophytes.Conclusions: In present study mixed infections of tinea cruris with corporis was the predominant clinical presentation and T. rubrum was the most common dermatophyte isolated.

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Transient coma as Percheron’s artery stroke

Journal of Health Sciences ◽

10.17532/jhsci.2019.696 ◽

2019 ◽

Author(s):

Maria sofia Cotelli ◽

Patrizia Civelli ◽

Elisa Tosana ◽

Marinella Turla

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Anatomic Variation ◽

Brain Structures ◽

Characteristic Pattern ◽

Caucasian Woman ◽

Arterial Trunk ◽

Artery Of Percheron ◽

The Brain ◽

Thalamic Infarcts

The artery of Percheron is a rare anatomic variation in the brain vascularization, in which a single arterial trunk arises from the posterior cerebral artery to supply both sides of brain structures, i.e., the thalamus and midbrain. Occlusion of this uncommon vessel results in a characteristic pattern of bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report the case of a Caucasian woman who completely recovers after transient coma due to Percheron artery infarction.

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Benign schwannoma in paranasal sinuses: a clinico-pathological study of five cases, emphasising diagnostic difficulties

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000527 ◽

2007 ◽

Vol 122 (6) ◽

pp. 598-602 ◽

Cited By ~ 14

Author(s):

H Y Sheikh ◽

R P Chakravarthy ◽

N J Slevin ◽

A J Sykes ◽

S S Banerjee

Keyword(s):

Malignant Disease ◽

Correct Diagnosis ◽

Rare Condition ◽

Benign Schwannoma ◽

Local Bone ◽

Appropriate Treatment ◽

Pathological Review ◽

Diagnostic Difficulties ◽

Clinical Awareness

AbstractObjectives:To highlight the difficulty in making a correct diagnosis of benign schwannoma in the paranasal region, to raise awareness of this rare condition, and to suggest the most appropriate treatment.Method:Retrieval of cases retrospectively from archives of the histopathology department of a major UK cancer centre with central review of all cases.Results:Five cases were identified since 1990 and clinical and pathological features are summarised. Median follow up of patients was 8.1 years. Radiological appearances of local bone invasion and histological features of tumour unencapsulation and hypercellularity could give the mistaken impression of malignant disease and lead to unnecessary over-treatment.Conclusion:Central pathological review and clinical awareness is required. Although local recurrence can occur, the prognosis is excellent. The treatment of choice is local excision. Radiotherapy can be considered, but in most cases it would incur unnecessary morbidity.

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Abnormalities of CSF Neurotransmitters/Folates

10.1093/med/9780199972135.003.0082 ◽

2016 ◽

Author(s):

Simon Heales ◽

Simon Pope ◽

Viruna Neergheen ◽

Manju Kurian

Keyword(s):

Pyridoxal Phosphate ◽

Clinical Presentation ◽

Correct Diagnosis ◽

Paediatric Population ◽

Acid Decarboxylase ◽

Primary Defect ◽

Inborn Errors ◽

Amino Acid Decarboxylase ◽

Aromatic Amino Acid Decarboxylase ◽

Appropriate Treatment

The term Neurotansmitter disorder, in the area of metabolic disease, focuses particularly on inborn errors affecting monoamine (dopamine & serotonin), pyridoxal phosphate (B6) and folate metabolism. Whilst there has been considerable focus on these disorders with regards to the paediatric population, it is clear that an increasing number of adult patients are being identified. Adult neurologists need to be aware of the clinical presentation of such patients and the appropriate tests that need to be requested to ensure a correct diagnosis is achieved. CSF profiling, by a specialist laboratory, is often required. This has the ability to very often identify the nature of a primary defect with regards to implementation of appropriate treatment. For some of these disorders, treatment can be effective. This may be in the form of monoamine/vitamin replacement. However there are exceptions, e.g. aromatic amino acid decarboxylase and dopamine transporter deficiencies. There also needs also to be an awareness of the growing list of secondary factors that can cause impaired dopamine and serotonin metabolism.

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1001 Intra-Articular Distal Radius Fracture Surgical Intervention Threshold Origins and Development

British Journal of Surgery ◽

10.1093/bjs/znab134.344 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

G Esworthy ◽

N Johnson ◽

J Dias ◽

P Divall

Keyword(s):

Distal Radius ◽

Clinical Presentation ◽

Surgical Intervention ◽

Threshold Value ◽

British Society ◽

Relevant Today ◽

Clinical Presentations ◽

Post Traumatic ◽

Current Guidance ◽

Traumatic Arthritis

Abstract Background Treatment of intra-articular distal radius fractures is guided by the displacement of the articular fragments. Symptomatic post-traumatic arthritis is expected to occur if step displacement is > 2mm; this value is often used as an indication for surgery if closed reduction is not possible. Method A systematic review was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results Knirk and Jupiter, 1986, are the first to quantify a threshold, with all their patients developing arthritis with >2mm displacement. Some papers have discussed using 1mm, although 2mm is most widely reported. Current guidance from the British Society for Surgery of the Hand supports 2mm. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, the radiological arthritis does not correlate with the clinical presentation. Conclusions Knirk and Jupiter originated the threshold value of 2mm. The lack of correlation between the radiological and clinical presentations warrants further investigation. The principle of treatment remains restoration of normal anatomical position.

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Neonatal screening and genotype-phenotype correlation of hyperphenylalaninemia in the Chinese population

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01846-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xin Wang ◽

Yanyun Wang ◽

Dingyuan Ma ◽

Zhilei Zhang ◽

Yahong Li ◽

...

Keyword(s):

Neonatal Screening ◽

Phenylalanine Hydroxylase ◽

Laboratory Data ◽

Molecular Characteristics ◽

Phenotype Correlation ◽

Common Amino Acid ◽

Appropriate Treatment ◽

Clinical Presentations ◽

Average Current

Abstract Background Hyperphenylalaninemia (HPA) is the most common amino acid metabolic disease involving phenylalanine hydroxylase (PAH, OMIM*612,349) deficiency or coenzyme tetrahydrobiopterin (BH4) deficiency. Patients with severe HPA often have a difficult life. Early diagnosis of HPA before the development of symptoms is possible via neonatal screening, facilitating appropriate treatment and reducing mortality and disability rates. This study revealed the prevalence, mutational and phenotypic spectrum, and prognosis of HPA by neonatal screening from January 2001 to September 2020 in Nanjing, Jiangsu Province, China. Methods Through a retrospective analysis of the information available in the neonatal screening database, the clinical presentations, laboratory data, molecular characteristics and treatment follow-up data of HPA patients detected by neonatal screening were evaluated. Results We diagnosed 181 patients with HPA from 1 to 957 newborns, giving an incidence of 1:6873. Among these patients, 177 were identified as PAH deficient and four patients were BH4 deficient. The average current age of the patients was 6.38 years old. The most common mutations of PAH were c.728 C > A/ p.Arg243Gln (13.83 %), c.158G > A/ p.Arg53His (9.57 %), c.611 A > G/ p.Tyr204Cys (7.44 %), and c.721 C > T/ p.Arg241Cys (6.38 %). Conclusions This study revealed the prevalence, phenotype-genotype, and prognosis of HPA in China and contributes to the updating of PAHD data for China and worldwide. Our study not only expanded the spectrum of phenotypes and genotype but also provided a valuable tool for improved genetic counseling and management of future cases.

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Case series on variable presentations of tuberculosis of the breast

BMJ Case Reports ◽

10.1136/bcr-2020-236019 ◽

2020 ◽

Vol 13 (12) ◽

pp. e236019

Author(s):

Tharun Ganapathy Chitrambalam ◽

Jeyakumar Sundaraj ◽

Pradeep Joshua Christopher ◽

Ramyasree Paladugu

Keyword(s):

Clinical Presentation ◽

Case Series ◽

Common Type ◽

Breast Abscess ◽

Breast Lump ◽

Clinical Presentations ◽

Malignant Lesions

Tuberculosis (TB) of the breast is extremely rare and is often mistaken for benign or malignant lesions of the breast. They are rare even in countries which are endemic for TB, like India. The most common type of clinical presentation is a vague lump in the breast, but there are even other types of presentations which are documented. In olden days, there was a lot of dilemma and challenge in diagnosing TB of the breast, but thanks to improved pathological knowledge and the advent of investigations such as QuantiFERON-TB gold and GeneXpert, TB can be diagnosed early nowadays and treated accordingly. In this study series, we report 10 cases of TB of the breast with variable clinical presentations as fibroadenosis, breast abscess, duct ectasia and breast lump on evaluation, and the challenges encountered in establishing the diagnosis.

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Clinical presentation of strokes confined to the insula: a systematic review of literature

Neurological Sciences ◽

10.1007/s10072-021-05109-1 ◽

2021 ◽

Author(s):

Vincenzo Di Stefano ◽

Maria Vittoria De Angelis ◽

Chiara Montemitro ◽

Mirella Russo ◽

Claudia Carrarini ◽

...

Keyword(s):

Systematic Review ◽

Clinical Presentation ◽

Insular Cortex ◽

Affective Processing ◽

Appropriate Treatment ◽

Insula Cortex ◽

Atypical Presentations ◽

High Level ◽

To Receive ◽

Insular Region

Abstract Background and purpose The insular cortex serves a wide variety of functions in humans, ranging from sensory and affective processing to high-level cognition. Hence, insular dysfunction may result in several different presentations. Ischemic strokes limited to the insular territory are rare and deserve a better characterization, to be quickly recognized and to receive the appropriate treatment (e.g. thrombolysis). Methods We reviewed studies on patients with a first-ever acute stroke restricted to the insula. We searched in the Medline database the keywords “insular stroke” and “insular infarction”, to identify previously published cases. Afterwards, the results were divided depending on the specific insular region affected by the stroke: anterior insular cortex (AIC), posterior insular cortex (PIC) or total insula cortex (TIC). Finally, a review of the clinical correlates associated with each region was performed. Results We identified 25 reports including a total of 49 patients (59.7 ± 15.5 years, 48% male) from systematic review of the literature. The most common clinical phenotypes were motor and somatosensory deficits, dysarthria, aphasia and a vestibular-like syndrome. Atypical presentations were also common and included dysphagia, awareness deficits, gustatory disturbances, dysautonomia, neuropsychiatric or auditory disturbances and headache. Conclusions The clinical presentation of insular strokes is heterogeneous; however, an insular stroke should be suspected when vestibular-like, somatosensory, speech or language disturbances are combined in the same patient. Further studies are needed to improve our understanding of more atypical presentations.

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An intrasellar germinoma with normal tumor marker concentrations mimicking primary lymphocytic hypophysitis

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302013000700012 ◽

2013 ◽

Vol 57 (7) ◽

pp. 566-570 ◽

Cited By ~ 8

Author(s):

Mariana F. Guzzo ◽

Cristina B. Formiga Bueno ◽

Thiago T. Amancio ◽

Sergio Rosemberg ◽

Cleonice Bueno ◽

...

Keyword(s):

Clinical Laboratory ◽

Correct Diagnosis ◽

Careful Analysis ◽

Malignant Neoplasms ◽

Pituitary Hormone ◽

Appropriate Treatment ◽

Suprasellar Region ◽

Neoplastic Lesions ◽

Posterior Pituitary Hormone ◽

Pituitary Stalk Thickening

Intracranial germinomas (GE) are malignant neoplasms most commonly found in the suprasellar region, which may cause anterior and particularly posterior pituitary hormone deficits with central diabetes insipidus (DI). Differential diagnosis of pituitary stalk thickening includes granulomatous, inflammatory, infectious, and neoplastic lesions. Although careful analysis of clinical, laboratory, and imaging findings may facilitate the diagnosis, transsphenoidal biopsy is indicated to confirm the disease, as the correct diagnosis directs the appropriate treatment.

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