Bilateral thalamic infarction due to artery of Percheron occlusion: a case report

The artery of Percheron is a rare variant of the posterior cerebral circulation. It is characterised by a single arterial trunk that supplies blood to bilateral paramedian thalami and rostral midbrain. Its occlusion can have a very wide range of presentation, and initial imaging including CT of the head maybe normal. Diagnosis and eventual treatment is usually delayed. We describe the case of an elderly man who presented with loss of consciousness, aphasia, and bilateral lower limb weakness. He was diagnosed with bilateral thalamic infarction due to the occlusion of the artery of Percheron only after an MRI of the brain was performed. Despite treatment his symptoms did not resolve completely. Keywords: Thalamus/blood supply, Cerebral arteries, Magnetic Resonance Imaging.

Bilateral thalamic infarction following cerebral venous thrombosis in a patient with ulcerative colitis

Although the risk of thromboembolism is increased in patients with ulcerative colitis, cerebral venous thrombosis is a rare complication in a patient with ulcerative colitis. We herein present an unusual case of a young female with Ulcerative Colitis under treatment diagnosed with cerebral venous thrombosis and bilateral thalamic infarction

Unilateral Thalamic Infarction Associated with Rupture of Dissecting Posterior Cerebral Artery in Childhood-Onset Systemic Lupus Erythematosus: A Case Report

BackgroundCerebrovascular diseases are well-known complications of systemic lupus erythematosus (SLE). Among them, cerebral arterial dissection is a rare vascular complication, in which an intimal tear of the blood vessel leads to an intramural hematoma. Cerebral arterial dissection leads to arterial stenosis, thrombosis, and aneurysm, resulting in cerebral infarction or subarachnoid hemorrhage (SAH). Herein, we report a case of posterior cerebral artery (PCA) dissection in SLE that presented as unilateral thalamic infarction followed by SAH and intraventricular hemorrhage (IVH). Case PresentationA 16-year-old boy hospitalized with prolonged fever, hair loss, and skin eruption was newly diagnosed with SLE based on the 2019 EULAR/ACR SLE classification criteria. He suddenly complained of headache, diplopia, and impairment of lateral gaze during hospitalization. Brain magnetic resonance imaging revealed left thalamic infarction, although cerebral vessel inflammation or thrombosis was not observed. Antiphospholipid antibodies such as lupus anticoagulant, anti-cardiolipin antibody, and anti-β2-glycoprotein antibody were not detected. His symptoms improved with high-dose steroid, low-dose aspirin, and mannitol therapy. Five days later, he experienced severe headache and generalized tonic-clonic seizures. Brain computed tomography revealed SAH and IVH with hydrocephalus. Even though emergent external ventricular drainage was performed, the ventricle size did not decrease. Transfemoral cerebral angiography revealed a ruptured dissecting PCA pseudoaneurysm, and immediate coil embolization was successfully performed. The patient fully recovered without any neurologic sequelae, although he underwent ventriculoperitoneal shunting for hydrocephalus following SAH. ConclusionsTo the best of our knowledge, this is the first reported case of PCA dissection in a patient with childhood-onset SLE. Moreover, the subsequent progression from cerebral infarction to SAH caused by PCA dissection makes this case unique. In SLE patients presenting with cerebral infarction and hemorrhage, cerebral arterial dissection and pseudoaneurysm should be considered to achieve favorable outcomes.

Longitudinal Changes of Sensorimotor Resting-State Functional Connectivity Differentiate between Patients with Thalamic Infarction and Pontine Infarction

Purpose. We investigated the disparate influence of lesion location on functional damage and reorganization of the sensorimotor brain network in patients with thalamic infarction and pontine infarction. Methods. Fourteen patients with unilateral infarction of the thalamus and 14 patients with unilateral infarction of the pons underwent longitudinal fMRI measurements and motor functional assessment five times during a 6-month period (<7 days, at 2 weeks, 1 month, 3 months, and 6 months after stroke onset). Twenty-five age- and sex-matched controls underwent MRI examination across five consecutive time points in 6 months. Functional images from patients with left hemisphere lesions were first flipped from the left to the right side. The voxel-wise connectivity analyses between the reference time course of each ROI (the contralateral dorsal lateral putamen (dl-putamen), pons, ventral anterior (VA), and ventral lateral (VL) nuclei of the thalamus) and the time course of each voxel in the sensorimotor area were performed for all five measurements. One-way ANOVA was used to identify between-group differences in functional connectivity (FC) at baseline stage (<7 days after stroke onset), with infarction volume included as a nuisance variable. The family-wise error (FWE) method was used to account for multiple comparison issues using SPM software. Post hoc repeated-measure ANOVA was applied to examine longitudinal FC reorganization. Results. At baseline stage, significant differences were detected between the contralateral VA and ipsilateral postcentral gyrus (cl_VA-ip_postcentral), contralateral VL and ipsilateral precentral gyrus (cl_VL-ip_precentral). Repeated measures ANOVA revealed that the FC change of cl_VA-ip_postcentral differ significantly among the three groups over time. The significant changes of FC between cl_VA and ip_postcentral at different time points in the thalamic infarction group showed that compared with 7 days after stroke onset, there was significantly increased FC of cl_VA-ip_postcentral at 1 month, 3 months, and 6 months after stroke onset. Conclusions. The different patterns of sensorimotor functional damage and reorganization in patients with pontine infarction and thalamic infarction may provide insights into the neural mechanisms underlying functional recovery after stroke.

Peduncular hallucinosis after a thalamic stroke

Peduncular hallucinosis is a rare form of hallucinations consisting of vivid and nonthreatening colourful visual hallucinations. It was first described by French neurologist Jean Lhermitte in 1922. It sometimes includes distorted images of animals and people. Peduncular hallucinosis has been described after vascular and infective lesions of the mesencephalon and thalamus.We present a case of peduncular hallucinosis after a right thalamic infarction. This is a case of a 75-year-old Caucasian man with a previous medical history of hypertension and hyperlipidaemia who presented as a transfer from an outside hospital with transient left facial palsy, upper and lower extremity weakness. His symptoms resolved on arrival. CTA head and neck revealed focal filling defect in the basilar artery and a right posterior cerebral artery (PCA) occlusion at its origin. MRI brain without contrast revealed a right thalamic infarct. The patient had vivid hallucinations including his wife sleeping on his hospital bed, seeing his favourite book on the table while he had left it at home, seeing his dogs and a TV show on his room television while it was off. He was easily redirectable, and the hallucinations resolved over 2 days without pharmacological intervention. In cases of thalamic, midbrain or peduncular infarctions, physicians should be cognizant of the possibility of peduncular hallucinosis and inquire about hallucinations. New onset hallucinations in a patient with no prior psychiatric history presenting with concerns for stroke should prompt physicians to strongly consider peduncular hallucinosis.

Acute Percheron Infarction: A Precision Learning

Background: So far, the diagnosis of acute AOP infarction is uncommon. The purpose of our study was to characterize the relationship between the imaging spectrum of acute AOP infarction and its clinical manifestations and prognosis on the basis of 23 cases.Methods: A total of 23 patients with acute AOP infarction in our institution from 2014 to 2019 were reviewed retrospectively. All cases were evaluated with computed tomography (CT), magnetic resonance imaging (MRI), detailed clinical and evaluated prognosis used a modified Rankin scale (mRs), blood studies, electrocardiogram and transthoracic echocardiography. All standard risk factors were recorded in these patients. mRs scores 90 days after discharge. Results: We identified 4 various patterns of acute AOP infarction: (1) bilateral paramedian thalamic infarction (BPTI, 52%), (2) bilateral paramedian thalamic with rostral midbrain infarction (BPTRMI, 30%), (3) bilateral paramedian and anterior thalamic infarction (BPATI, 13%), and (4) bilateral paramedian thalamic with red nuclei infarction (BPTRNI, 4%). These patients had consciousness disorder, memory dysfunctions, vertical gaze paresis, mesencephalothalamic syndrome and so on. The 65% patients with BPTI and BPATI who experienced a good functional recovery and could carry out daily life activities (mRS score ≤ 2). However, patients with BPTRMI who have an unfavorable outcome.Conclusion: Although the clinical feature of patients with AOP infarction is variable, DWI or ADC map can improve the diagnosis of acute AOP infarction patterns. Acute AOP occlusion requires immediate diagnosis and treatment initiation for a more favorable outcome and additional unnecessary procedures.