Hyperthermia Associated with Bilateral Mesencephalothalamic Infarction

Assessment of Percheron infarction in images and clinical findings

OBJECTIVE

To assess the imaging and clinical features of patients with an artery of Percheron infarction comprehensively.

METHODS

Of 6539 patients with a first-ever stroke, 18 patients with a Percheron infarction were enrolled, and their images and clinical data were retrospectively investigated.

RESULTS

All patients underwent neurological intensive care unit (NICU) management. The initial symptom of a Percheron infarction included dizziness, transient blurred vision, double vision, barylalia, cerebellar ataxia, drowsiness, and a coma. Subsequent symptoms differed for the three subtypes of Percheron infarction, and the three subtypes are bilateral paramedian thalamic infarction with midbrain involvement, bilateral paramedian thalamic infarction without midbrain involvement, and bilateral paramedian and anterior thalamic infarction without midbrain involvement. Between favorable and unfavorable outcomes, there was no significant difference in the following patient characteristics including current smoking, hypertension, diabetes, hyperlipidemia, hyperhomocysteinemia, heart disease, time from stroke onset to medical care, and Glasgow Coma Scale score at admission (P>0.05), but there were significant differences in both the National Institute of Health stroke scale (NIHSS) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score at admission (P<0.05). If the midbrain or larger infarct volume was involved or hemorrhagic transformation occurred, outcomes of a Percheron infarction were frequently unfavorable.

CONCLUSION

The clinical presentation of patients with a Percheron infarction is variable; early recognition, image performance, NICU management, NIHSS, and APACHE II score would help in diagnosis, evaluation, and treatment.

[A 39 years old woman responding to modafinil with bilateral hypothalamic lesion associated with hyperthermia and hypersomnia: a case report]

A 39 years old woman was admitted to our hospital with a status epilepticus, with high fever of 41°C. Magnetic resonance Imaging (MRI) revealed high signal intensities of both sides of thalami and hypothalami in T2 weighted and fluid attenuated inversion recovery (FLAIR) images. A needle biopsy of the thalamic lesion was consistent with neuromyelitis optica spectrum disorder although her serum antibody to aquaporin-4 was negative. The level of orexin in celebrospinal fluid (CSF) was reduced. She presented hypersomnia, which didn't improve even after intravenous methylprednisolone 1 g daily for 3 days. Administration of oral modafinil extended her waking time. There is a number of reports about neuromyelitis optica (NMO) with hypothalamic lesions. We report this case as important suggestion of treatment of these cases.