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Bilateral Paramedian Thalamic Infarction.

Maximiliano A Hawkes¹, Julieta E Arena, Cecilia Rollán

¹Departments of *Neurology †Radiology, Raúl Carrea Institute for Neurological Research, FLENI, Ciudad autónoma de Buenos Aires, Buenos Aires, Argentina.

The Neurologist

|November 14, 2015

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Bilateral paramedian thalamic infarcts, often caused by artery of Percheron (AP) occlusion, present with diverse symptoms. Early diagnosis is crucial for effective treatment of this rare stroke type.

Area of Science:

Neurology
Vascular Neurology
Neuroimaging

Background:

The artery of Percheron (AP) is a rare anatomical variant where both paramedian thalami receive blood supply from a single unilateral vessel originating from the posterior cerebral artery.
Bilateral paramedian thalamic infarcts are uncommon, accounting for 0.1% to 2% of ischemic strokes, with AP occlusion being the primary cause, often due to cardioembolism.

Observation:

A study of 5 patients with bilateral paramedian thalamic infarcts due to probable AP occlusion revealed a mean age of 58±24 years.
Clinical presentation included loss of consciousness in 4 patients and abnormal ocular signs in 4, with MRI confirming thalamic lesions in all.
Mesencephalic infarct extension was noted in only one patient.

Findings:

Despite characteristic clinical and imaging findings, none of the patients received timely diagnosis or intravenous thrombolysis due to delayed presentation.

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Outcomes varied, with one patient fully recovering and four experiencing persistent cognitive and gaze abnormalities.

Implications:

A high index of suspicion based on clinical presentation and neuroimaging is essential for the early diagnosis of artery of Percheron-related thalamic infarcts.
Timely diagnosis and treatment are critical for improving outcomes in patients with this rare cerebrovascular event.