scholarly journals Isolated acute pseudobulbar palsy with infarction of artery of percheron: case report and literature review

2021 ◽  
Vol 21 (1) ◽  
pp. 166-71
Author(s):  
Jamir Pitton Rissardo ◽  
Ana Fornari Caprara
Keyword(s):  
Case Report ◽  
Brain Magnetic Resonance Imaging ◽  
Pseudobulbar Palsy ◽  
Clinical Syndromes ◽  
Artery Of Percheron ◽  
Apparent Diffusion ◽  
Tongue Movements ◽  
Swallowing Difficulty ◽  
Gag Reflex ◽  
Hypernasal Voice

Introduction: Pseudobulbar palsy (PBP) is characterized by supranuclear lesions in the corticobulbar pathway. Neoplasia, inflammatory, demyelinating, and stroke are possible etiologies of this disorder. Case report: We report an elderly female who presented with dysarthria. She was dysarthric with a hypernasal voice, no apraxia or aphasia was observed. Tongue movements were slow with limited amplitude. Her soft palate dropped bilaterally; gag reflex was present. Also, she reported swallowing difficulty and choking with her saliva. Bilateral vertical and horizontal gaze were intact to either voluntary or oculocephalic movements. A cranial CT scan was suggestive of artery of Percheron (AOP) infarction. Brain magnetic resonance imaging showed hypersignal on diffusion-weighted and T2-weighted images and hyposignal on apparent diffusion coefficient in both thalami. CT angiography scan revealed an AOP originating from the left posterior cerebral artery. The swallowing study with a videofluoroscopic demonstrated oral and pharyngeal phases with severe dysfunction. Conclusion: To the authors’ knowledge, there are two cases of individuals with artery of Percheron infarction who devel- oped PBP associated with other clinical syndromes. Still, isolated PBP following infarction of Percheron’s artery was not reported. We hypothesized that the PBP may have occurred because of the existence of vascular territory variations in the perforating arteries that arise from the AOP. Keywords: Pseudobulbar palsy; thalamus; infarction.

scholarly journals Artery of Percheron infarction: A case report and literature review

2021 ◽  
Vol 16 (6) ◽  
pp. 1271-1275
Author(s):  
Juna Musa ◽  
Masum Rahman ◽  
Ali Guy ◽  
Erisa Kola ◽  
Angela Guy ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Artery Of Percheron

Abstract 1122‐000205: Bilateral ACA Stroke ‐ A Case Report of an Unusual Presentation

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Tejeswi Suryadevara ◽  
Bhavya Narapureddy ◽  
Carlos Y Lopez ◽  
Karen C Albright
Keyword(s):  
Case Report ◽  
Brain Magnetic Resonance Imaging ◽  
Whole Body ◽  
Rapid Improvement ◽  
Stroke Registry ◽  
Disconnection Syndrome ◽  
Leg Weakness ◽  
Anatomic Variants ◽  
Computed Tomography Angiogram ◽  
Cerebrovascular Risk

Introduction : Bilateral ACA strokes are rare, with one stroke registry reporting 2 cases out of 1490 strokes (1). These strokes are even less common in the absence of anatomic variants, such as an azygos ACA. Diagnosis may be difficult given the variability in clinical presentation. Methods : This is a case report. Results : A 51‐year‐old right handed man with no cerebrovascular risk factors on no antithrombotic medications presented two hours from last known well with complaints of generalized weakness, inability to speak or move, and feeling numb all‐over during intercourse. He reported rapid improvement in symptoms. Emergency room exam was notable for right leg weakness (3/5) and left leg plegia with intact sensation. Hoover’s sign was positive in the left leg and the patient was able to bear some weight while standing with a two‐person assist. A computed tomography angiogram (CTA) of his head and neck was preliminarily interpreted as normal. No azygos ACA or single internal carotid artery origin for the ACAs were present. His exam improved to an isolated left foot dorsiflexor and plantar flexor weakness. The decision was made not to use thrombolytics based on his symptoms and exam which were improving and not entirely consistent with acute stroke. Brain magnetic resonance imaging demonstrated bilateral parasagittal acute strokes. It was later noted the that non‐contrast head CT demonstrated bilateral hyperdense ACAs. Conclusions : This case demonstrates the difficulty in diagnosing bilateral ACA infarcts in a previously healthy adult in the setting of whole‐body numbness and positive Hoover’s sign. In retrospect, his transient inability to speak or move may have been transient akinetic mutism or callosal disconnection syndrome. Additionally, this case emphasizes the importance of evaluating for the hyperdense ACA sign (2) in patients complaining of bilateral leg weakness.

scholarly journals Artery of Percheron infarction: review of literature with a case report

2015 ◽  
Vol 49 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Urska Lamot ◽  
Ivana Ribaric ◽  
Katarina Surlan Popovic
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Clinical Features ◽  
Cerebral Circulation ◽  
Brain Ct ◽  
Ischemic Infarction ◽  
Artery Of Percheron ◽  
Imaging Approach ◽  
Intracranial Arteries ◽  
Posterior Cerebral Circulation

Abstract Background. Clinical features indicating an ischemic infarction in the territory of posterior cerebral circulation require a comprehensive radiologic examination, which is best achieved by a multi-modality imaging approach (computed tomography [CT], CT-perfusion, computed tomography angiography [CTA], magnetic resonance imaging [MRI] and diffusion weighted imaging [DWI]). The diagnosis of an acute ischemic infarction, where the damage of brain tissue may still be reversible, enables selection of appropriate treatment and contributes to a more favourable outcome. For these reasons it is essential to recognize common neurovascular variants in the territory of the posterior cerebral circulation, one of which is the artery of Percheron. Case report. A 69 year-old woman, last seen awake 10 hours earlier, presented with two typical clinical features of the artery of Percheron infarction, which were vertical gaze palsy and coma. Brain CT and CTA of neck and intracranial arteries upon arrival were interpreted as normal. A new brain CT scan performed 24 hours later revealed hypodensity in the medial parts of thalami. Other imaging modalities were not performed, due to the presumption that the window for the application of effective therapy was over. The diagnosis of an artery of Percheron infarction was therefore made retrospectively with the re-examination of the CTA of neck and intracranial arteries. Conclusions. A multi-modality imaging approach is necessary in every patient with suspicion of the posterior circulation infarction immediately after the onset of symptoms, especially in cases where primary imaging modalities are unremarkable and clinical features are severe, where follow-up examinations are indicated.

scholarly journals The Role of Apparent Diffusion Coefficient in the Differentiation between Cerebellar Medulloblastoma and Brainstem Glioma

2020 ◽  
Vol 12 (3) ◽  
pp. 34-40
Author(s):  
Pham Minh Thong ◽  
Nguyen Minh Duc
Keyword(s):  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Brain Magnetic Resonance Imaging ◽  
Brainstem Glioma ◽  
Youden Index ◽  
Roc Curve Analysis ◽  
Apparent Diffusion ◽  
Cerebellar Medulloblastoma ◽  
Group 2 ◽  
Group 1

For certain clinical circumstances, the differentiation between cerebellar medulloblastoma and brainstem glioma is essential. We aimed to evaluate the role played by the apparent diffusion coefficient (ADC) values in the differentiation between cerebellar medulloblastomas and brainstem gliomas in children. The institutional review board approved this prospective study. Brain magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) and ADC, was assessed in 32 patients (median age: 7.0 years), divided into two groups, a medulloblastoma group (group 1, n = 22) and a brainstem glioma group (group 2, n = 10). The Mann–Whitney U test was utilized to compare tumor ADCmax, ADCmin, ADCmean, and ADCsd values, and their ratios with the parenchyma values between the two groups. Receiver operating characteristic (ROC) curve analysis and the Youden index were used to calculate the cut-off value, along with the area under the curve (AUC), sensitivity, and specificity. The median ADCmax, ADCmin, and ADCmean values were significantly higher in group 2 than in group 1 (p < 0.05). The median ratios of ADCmin and ADCmean to the parenchyma were significantly higher in group 2 than in group 1 (p < 0.05). The ROC analysis showed that the AUC for the ADCmean ratio was the highest among these parameters, at 98.2%. The ADCmean tumor to parenchyma ratio was a significant and effective parameter for the differentiation between pediatric medulloblastomas and brainstem gliomas.

scholarly journals Artery of Percheron infarction: a case report

2017 ◽  
Vol 11 (1) ◽  
Author(s):  
Axel Sandvig ◽  
Sandra Lundberg ◽  
Jiri Neuwirth
Keyword(s):  
Case Report ◽  
Artery Of Percheron

Poster 293: Artery of Percheron Infarction: A Case Report

PM&R ◽  
2018 ◽  
Vol 10 ◽  
pp. S97-S97
Author(s):  
Firas Y. Rafati ◽  
Marilyn S. Pacheco ◽  
Disha R. Patel
Keyword(s):  
Case Report ◽  
Artery Of Percheron

Reversible Foix-Chavany-Marie syndrome after right operculo-insular contusion from a spear gun trauma through the cranial base

2018 ◽  
Vol 2 (1) ◽  
pp. 30-33
Author(s):  
Marcus André Acioly ◽  
Marcílio Diogo de Oliveira Barbosa ◽  
Rosemary Tavares Pontes ◽  
Marcos Müller ◽  
Guilherme Brasileiro de Aguiar
Keyword(s):  
Cranial Base ◽  
Severe Form ◽  
Pseudobulbar Palsy ◽  
Facial Weakness ◽  
Rare Type ◽  
Submandibular Region ◽  
Vessel Injury ◽  
Major Vessel ◽  
Gag Reflex

Abstract Background and object Foix-Chavany-Marie syndrome (FCMS) is a rare type of pseudobulbar palsy, which is characterized by anarthria or severe dysarthria and bilateral central facio-linguo-velo-pharyngo-mastigatory paralysis with “automatic voluntary dissociation”. We report on a patient who suffered a reversible FCMS following a spear gun trauma through the cranial base leading to right operculo-insular contusion. Case Report This 28-year-old lady attempted suicide by shooting a spear gun into the head through her right submandibular region. Major vessel injury was ruled out and the patient was taken to the operating room for shaft removal. Postoperatively, we observed the mouth half open, drooling saliva, inability to move her tongue, anarthria, bilateral facial weakness, and loss of the gag reflex. Yawning was otherwise preserved resulting in a clinical diagnosis of FCMS. Postoperative imaging demonstrated a right operculoinsular contusion. Symptoms were fully recovered after two years of follow-up. Conclusion FCMS is a rare and severe form of pseudobulbar palsy. Unilateral lesions are exceptional but should be recognized, as we presented. Generally, the outcome is moderate to poor but the occurrence in brain trauma can be associated with complete functional recovery.

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