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Mohammadian M, Damati A. A Rare Neurological Presentation Post-Cardiac Catheterization. Cureus 2022; 14:e22948. [PMID: 35411266 PMCID: PMC8988465 DOI: 10.7759/cureus.22948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/05/2022] Open
Abstract
Unilateral Isolated oculomotor nerve palsy is a rare neurological complication after cardiac catheterization. Concomitant thalamus and midbrain infarction secondary to embolic events involving the artery of Percheron after cardiac catheterization have been reported in the literature. However, isolated midbrain infarction is a rare neurological deficit. Here, we present the case of a patient who presented with mild left-sided ptosis, binocular diplopia, and partially impaired left eye adduction two hours after cardiac catheterization. Brain magnetic resonance imaging revealed a focal area of restricted diffusion within the midbrain tegmentum, confirming this rare brainstem stroke.
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Saida IB, Saad HB, Zghidi M, Ennouri E, Ettoumi R, Boussarsar M. Artery of Percheron Stroke as an Unusual Cause of Hypersomnia: A Case Series and a Short Literature Review. Am J Mens Health 2021; 14:1557988320938946. [PMID: 32618485 PMCID: PMC7336829 DOI: 10.1177/1557988320938946] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Imen Ben Saida
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia.,Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Helmi Ben Saad
- Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.,Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Maroua Zghidi
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - Emna Ennouri
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - Radhouane Ettoumi
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia.,Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Mohamed Boussarsar
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia.,Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
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SINDROME DE PERCHERON INFARTO TALÁMICO BILATERAL: REPORTE DE 2 CASOS. REVISTA MÉDICA CLÍNICA LAS CONDES 2019. [DOI: 10.1016/j.rmclc.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Khanni JL, Casale JA, Koek AY, Espinosa Del Pozo PH, Espinosa PS. Artery of Percheron Infarct: An Acute Diagnostic Challenge with a Spectrum of Clinical Presentations. Cureus 2018; 10:e3276. [PMID: 30443447 PMCID: PMC6235647 DOI: 10.7759/cureus.3276] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The artery of Percheron (AOP) is a variant of the paramedian thalamic vasculature that supplies blood to the medial aspect of the thalamus and the rostral midbrain. The presentation of an infarct in this territory varies widely and is often characterized by nonspecific neurological deficits, with altered mental status, decreased level of consciousness, and memory impairment being among the most common. AOP infarcts are often missed on initial computed tomography (CT) scan, and additional imaging is usually not done due to low suspicion for stroke in most cases. There have been an increasing number of reports of AOP infarction, illustrating the diversity of clinical presentations and the challenge this presents to clinicians in the acute setting. Lacking the classic signs of stroke, many of these patients experience a delay in recognition and treatment, with the majority of diagnoses occurring outside the tissue plasminogen activator (tPA) window. This case highlights the unusual presentation and diagnostic difficulty of a patient with an AOP infarct, and serves as a reminder to include thalamic pathology in patients presenting with vague neurological symptoms and no obvious signs of stroke.
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Affiliation(s)
- Javed L Khanni
- Clinical Biomedical Science, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Joel A Casale
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Adriana Y Koek
- Clinical Biomedical Science, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | | | - Patricio S Espinosa
- Neurology, Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, USA
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Dhikav V, Anand KS. Commentary. J Neurosci Rural Pract 2018; 9:169-170. [PMID: 29456369 PMCID: PMC5812150 DOI: 10.4103/jnrp.jnrp_435_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Vikas Dhikav
- Department of Neurology, Memory Clinic, Dr. Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Kuljeet Singh Anand
- Department of Neurology, Memory Clinic, Dr. Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
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Oliveira GDP, Truzzi G, Lima FCB, Coelho FMS. A rare differential diagnosis of excessive daytime sleepiness - Artery of Percheron territory infarct. ACTA ACUST UNITED AC 2018; 11:25-27. [PMID: 29796197 PMCID: PMC5916572 DOI: 10.5935/1984-0063.20180006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stroke is an example of neurological diseases that can commonly drives Excessive
Daytime Sleepiness (EDS). Extensive strokes with brain edema can leave a brain
herniation and coma. Other causes of EDS after stroke are strategic lesions at
Thalamus and brainstein. A 56-year-old man, right handed, with hypertension and
hypercholesterolemia was admitted at Emergency Room due to 5 days onset of EDS,
memory impairment, and left-sided weakness. A brain magnetic resonance imaging
showed paramedian thalamic hyperintensity with rostral midbrain hyperintensity
extending along the pial surface of the interpeduncular fossa. The artery of
Percheron (AP) is an unusual anatomical variation that originates from the
posterior cerebral artery and irrigates the paramedian regions of the thalamus
and part of the midbrain. It is important the clinical suspicions with detailed
drowsy patients history. Awareness of the clinical and neuroimaging features of
this stroke syndrome is essential for timely diagnosis and appropriate
management.
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Affiliation(s)
- Giuliano da Paz Oliveira
- Universidade Federal de São Paulo, Department of Neurology e Neurosurgery - São Paulo, SP, - Brazil.,Universidade Federal do Piauí, Campus Ministro Reis Velloso, Medicine Coordination - Parnaíba, PI, Brazil.,Universidade Federal de São Paulo, Department of Psychobiology - São Paulo, SP, Brazil
| | - Giselle Truzzi
- Universidade Federal de São Paulo, Department of Psychobiology - São Paulo, SP, Brazil
| | | | - Fernando Morgadinho Santos Coelho
- Universidade Federal de São Paulo, Department of Neurology e Neurosurgery - São Paulo, SP, - Brazil.,Universidade Federal de São Paulo, Department of Psychobiology - São Paulo, SP, Brazil
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DiFrancesco JC. Artery of Percheron ischaemic stroke revealed by brain MRI DWI/ADC sequences. BMJ Case Rep 2017; 2017:bcr-2017-223092. [DOI: 10.1136/bcr-2017-223092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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