scholarly journals Bilateral thalamic infarction secondary to artery of Percheron occlusion: A rare cause of acute coma

2021 ◽  
Vol 7 (4) ◽  
pp. 17
Author(s):  
James Edward Brady ◽  
Keith Anthony Brown ◽  
Raqiya Shoaib ◽  
David Roshal
Keyword(s):  
Delayed Diagnosis ◽  
Artery Occlusion ◽  
Sudden Onset ◽  
Clinical Syndrome ◽  
Diagnostic Challenge ◽  
Anatomical Variant ◽  
Neurologic Outcomes ◽  
Artery Of Percheron ◽  
Thalamic Infarction ◽  
Variable Presentation

An occlusion of the artery of Percheron (AOP) is a rare clinical condition that remains a diagnostic challenge for physicians given its variable presentation. This infarction is a result of an anatomical variant of a single vessel arising from the posterior cerebral artery. Occlusion of the AOP results in variable levels of alteration of consciousness, vertical gaze palsy, and memory impairment. Unfortunately, due to this variable presentation these strokes are often missed. We report a case of a 71 year-old-female who presented with sudden onset of unresponsiveness who was subsequently diagnosed with bilateral thalamic infarction with midbrain involvement secondary to AOP occlusion. Delayed diagnosis can result in poor neurologic outcomes as demonstrated in this case making it imperative to bring further awareness to this clinical syndrome.

scholarly journals Artery of Percheron Stroke as an Unusual Cause of Hypersomnia: A Case Series and a Short Literature Review

2020 ◽  
Vol 14 (4) ◽  
pp. 155798832093894
Author(s):  
Imen Ben Saida ◽  
Helmi Ben Saad ◽  
Maroua Zghidi ◽  
Emna Ennouri ◽  
Radhouane Ettoumi ◽  
...  
Keyword(s):  
Memory Impairment ◽  
Case Series ◽  
Sudden Onset ◽  
Diagnostic Challenge ◽  
Anatomical Variant ◽  
Clinical Presentations ◽  
Artery Of Percheron ◽  
Delayed Complication ◽  
Vertical Gaze ◽  
Gaze Palsy

The thalamus and the mesencephalon have a complex blood supply. The artery of Percheron (AOP) is a rare anatomical variant. Occlusion of this artery may lead to bithalamic stroke with or without midbrain involvement. Given its broad spectrum of clinical features, AOP stroke is often misdiagnosed. Usually, it manifests with the triad of vertical gaze palsy, memory impairment, and coma. In this article, we report three cases of bilateral thalamic strokes whose clinical presentations were dominated by a sudden onset of hypersomnia. We also reviewed last 5 years’ publications related to the AOP strokes in males presenting sleepiness or equivalent terms as a delayed complication. The AOP stroke may present a diagnostic challenge for clinicians which should be considered in the differential diagnosis of hypersomnia.

scholarly journals Emergency Department and Radiological Cost of Delayed Diagnosis of Cannabinoid Hyperemesis

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
David I. Zimmer ◽  
Ross McCauley ◽  
Varun Konanki ◽  
Joseph Dynako ◽  
Nuha Zackariya ◽  
...  
Keyword(s):  
Emergency Department ◽  
Delayed Diagnosis ◽  
The United States ◽  
Clinical Syndrome ◽  
Cannabis Use ◽  
Diagnostic Challenge ◽  
High Clinical Suspicion ◽  
Ed Visits ◽  
Inappropriate Utilization ◽  
Utilization Of Healthcare

Background. Chronic cannabis use has become prevalent with decriminalization, medical prescription, and recreational legalization in numerous US states. With this increasing incidence of chronic cannabis use a new clinical syndrome has become apparent in emergency departments and hospitals across the country, termed Cannabinoid Hyperemesis (CH). CH has been described as cyclical vomiting and abdominal pain in the setting of chronic cannabis use, which is often temporarily relieved by hot showers. CH presents a diagnostic challenge to clinicians who do not have a high clinical suspicion for the syndrome and can result in high costs and resource utilization for hospitals and patients. This study investigates the expenditures associated with delayed CH evaluation and delayed diagnosis. Methods. This is a retrospective observational study of 17 patients diagnosed with CH at three medical centers in the United States from 2010 to 2015, consisting of two academic centers and a community hospital. Emergency department (ED) costs were calculated and analyzed for patients eventually diagnosed with CH. Results. For the 17 patients treated, the total cost for combined ED visits and radiologic evaluations was an average of $76,920.92 per patient. On average these patients had 17.9 ED visits before the diagnosis of CH was made. Conclusion. CH provides a diagnostic challenge to clinicians without a high suspicion of the syndrome and may become increasingly prevalent with current trends toward cannabis legalization. The diagnosis of CH can be made primarily through a thorough history and physical examination. Awareness of this syndrome can save institutions money, prevent inappropriate utilization of healthcare resources, and save patients from unnecessary diagnostic tests.

scholarly journals Bithalamic Infarction (Artery of Percheron Occlusion) after Anterior Cervical Discectomy and Fusion

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Hatem B. Afana ◽  
Nidal M. M. Abuhadrous ◽  
Alaa Eldin Elsharkawy
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Loss Of Consciousness ◽  
Cervical Discectomy ◽  
Sudden Loss ◽  
Cervical Spine Surgery ◽  
Artery Of Percheron ◽  
Thalamic Infarction

Bithalamic infarction resulting from occlusion of the artery of Percheron after cervical spine surgery is a rare pathological entity. Diagnosis and early detection are challenging. Prompt management may help to improve the outcome. We present a case of a 39-year-old male patient, smoker, diagnosed with multiple cervical disc herniations, who underwent Anterior Cervical Discectomy and Fusion (ACDF) for C3-C4, C4-C5, and C5-C6. During the 2-hour and 50-minute surgery, the patient was lying supine with his neck hyperextended. The intraoperative procedure was uneventful. During surgery, blood pressure ranged around 110 mmHg∖50 mmHg. At the end of surgery, the patient’s recovery from general anesthesia was normal with no delaying or complication; on next the day, patient developed a sudden loss of consciousness. Urgent brain computed tomography (CT) was normal; two days later, follow-up CT and CT Angiography (CTA) revealed bilateral thalamic infarction with right vertebral artery occlusion from its origin. Intraoperative surgical manipulation, hypotensive anesthesia, and prolonged neck hyperextension might have contributed to stroke in this patient. ACDF carries a potential risk for posterior circulation stroke. Artery of Percheron infarction should be considered in the differential diagnosis of patients developing a sudden loss of consciousness after ACDF. Vertebral artery thrombosis should be taken into account as an important possible cause of embolism.

scholarly journals Artery of Percheron territory infarct in a young patient with thrombophilia

2021 ◽  
Author(s):  
Clara Kimie Miyahira ◽  
Beatriz Medeiros Correa ◽  
Raphael Palomo Barreira ◽  
Thomas Zurga Markus Torres ◽  
Natália Figueiredo Miranda ◽  
...  
Keyword(s):  
Pressure Control ◽  
Secondary Prophylaxis ◽  
Heterozygous Mutation ◽  
Factor V ◽  
Blurred Vision ◽  
Cognitive Changes ◽  
Anatomical Variant ◽  
Artery Of Percheron ◽  
Thalamic Infarction ◽  
Level Of Consciousness

Context: Stroke, when affecting territories dependent on posterior circulation, affects the thalamus and mesencephalic structures, regions irrigated by the paramedian arteries and perforating arteries of the posterior communicating artery and posterior cerebral artery. However, there is an anatomical variant of the paramedian arteries, the Percheron artery, when occluded causes bilateral thalamic infarction. Case report: a 53-year-old woman who presented blurred vision, holocranial headache, hypertensive peak, decreased level of consciousness, anisocoria, conjugate eye deviation. Tomography was normal and after 48 hours there was periventricular hypodensity of white matter, corona radiate and bilateral thalamic. Cerebral angiography confirmed moderate stenosis in the cavernous segments of the internal carotid arteries. In the investigation, a heterozygous mutation for factor V of Leiden was found. The patient evolved well, after blood pressure control and secondary prophylaxis. Clinical picture brings the classic triad of Percheron Artery infarction: decreased level of consciousness, vertical changes in the look and cognitive changes in memory and learning. Other symptoms could be found hypersomnia, oculomotor paralysis and ataxia. The diagnosis is clinical and radiological by visualizing bilateral thalamic involvement. Predisposing factors should be investigated, such as the Leiden factor V mutation, which increases thromboembolic events. Conclusion: It is important to research risk factors and execute an early diagnosis for acute intervention and prophylaxis of stroke.

Complex effects of apoplexy secondary to pituitary adenoma

2017 ◽  
Vol 28 (1) ◽  
pp. 59-64 ◽  
Author(s):  
Rui-Cheng Zhang ◽  
Ying-Feng Mu ◽  
Jing Dong ◽  
Xiao-Qian Lin ◽  
De-Qin Geng
Keyword(s):  
Pituitary Adenoma ◽  
Case Reports ◽  
Spontaneous Remission ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Sudden Onset ◽  
Clinical Syndrome ◽  
Metabolic Demand ◽  
Releasing Factors ◽  
High Metabolic Demand

AbstractPituitary adenoma apoplexy is a well-known clinical syndrome induced by insulin infusion, cardiac surgery, trauma, and hypothalamic releasing factors. Pituitary apoplexy can cause secondary cerebral infarct and internal carotid artery occlusion. With blockade of tumor perfusion, apoplexy triggers a sudden onset of headache, visual impairment, cranial nerve palsy, disturbances of consciousness, eyelid ptosis, and hemiparesis. However, pituitary adenoma cells with high metabolic demand cannot survive with deficient blood supply and glucose concentrations. Moreover, a number of case reports have shown that spontaneous remission of syndromes, such as acromegaly, may be caused by pituitary adenoma after apoplexy. Therefore, understanding mechanism that underlies the balance between pituitary adenoma apoplexy and subsequent spontaneous remission of syndromes may suggest new approaches for treatment of pituitary adenoma apoplexy.

scholarly journals Bilateral thalamic stroke in patient with patent foramen ovale and hereditary thrombophilia

2018 ◽  
Vol 90 (11) ◽  
pp. 62-66
Author(s):  
M Yu Brovko ◽  
L A Akulkina ◽  
V I Sholomova ◽  
A Sh Yanakayeva ◽  
L A Strizhakov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Patent Foramen Ovale ◽  
Artery Occlusion ◽  
Single Source ◽  
Foramen Ovale ◽  
Anatomical Variant ◽  
Hereditary Thrombophilia ◽  
Thalamic Stroke ◽  
Artery Of Percheron

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

Refractory Ascites as the Only Presenting Symptom of Chronic Calcified Constrictive Pericarditis: A Diagnostic Challenge

2014 ◽  
Vol 17 (1) ◽  
pp. 42
Author(s):  
Shi-Min Yuan
Keyword(s):  
Computed Tomography ◽  
Liver Cirrhosis ◽  
Female Patient ◽  
Constrictive Pericarditis ◽  
Delayed Diagnosis ◽  
Young Female ◽  
Refractory Ascites ◽  
Diagnostic Challenge ◽  
Massive Ascites ◽  
History Of

Extracardiac manifestations of constrictive pericarditis, such as massive ascites and liver cirrhosis, often cover the true situation and lead to a delayed diagnosis. A young female patient was referred to this hospital due to a 4-year history of refractory ascites as the only presenting symptom. A diagnosis of chronic calcified constrictive pericarditis was eventually established based on echocardiography, ultrasonography, and computed tomography. Cardiac catheterization was not performed. Pericardiectomy led to relief of her ascites. Refractory ascites warrants thorough investigation for constrictive pericarditis.

scholarly journals Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis

2021 ◽  
Author(s):  
Ayah Megahed ◽  
Rahul Hegde ◽  
Pranav Sharma ◽  
Rahmat Ali ◽  
Anas Bamashmos
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Pleural Fluid ◽  
Rare Complication ◽  
Delayed Diagnosis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pleural Effusions ◽  
Diagnostic Challenge ◽  
Abdominal Symptoms ◽  
Pancreatic Duct Stenting

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

Heart failure in an elderly population

2001 ◽  
Vol 11 (4) ◽  
pp. 311-321
Author(s):  
DN Carmichael ◽  
Michael Lye
Keyword(s):  
Heart Failure ◽  
Treatment Options ◽  
Clinical Syndrome ◽  
Point Of View ◽  
Diagnostic Challenge ◽  
The Common ◽  
Characteristic Features ◽  
The Many ◽  
Neuroendocrine Activation ◽  
Symptoms And Signs

Heart failure has been defined in many ways and definitions change over time. The multiplicity of definitions reflect the paucity of our understanding of the primary underlying physiology of heart failure and the many diseases for which heart failure is the common end-point. Fundamentally, heart failure represents a failure of the heart to meet the body’s requirement for blood supply for whatever reason. It is thus a clinical syndrome with characteristic features – not a single disease in its own right. The syndrome includes symptoms and signs of organ underperfusion, fluid retention and neuroendocrine activation. The syndrome arises from a range of possible causes of which ischaemic heart disease is the commonest. From the point of view of a clinician, the underlying pathology will determine treatment options and prognosis. The extensive range of possible aetiologies present a diagnostic challenge both to correctly identify the syndrome amongst all other causes of dyspnoea and to identify the aetiology, allowing optimization of treatment.

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