Neuropsychological Symptoms and Therapy in Patient with a Bilateral Thalamic Ischemic Stroke Due to the Artery of Percheron Territory Infarct (original) (raw)
Related papers
Acute confusional state in a patient with bilateral thalamic ischemic stroke
Romanian Journal of Neurology, 2022
The acute confusional state is one of the most common reasons for neurologic consultation in the hospital setting and the plethora of causes can truly be daunting. The etiology can vary from structural, metabolic, toxic to systemic infections. Our purpose is to present a rare case of acute confusional state in a patient with bilateral thalamic ischemic stroke due to occlusion of the artery of Percheron (AOP). A 79-year-old woman with a history of hypertension and surgery for lumbar disc herniation, managed on antiplatelet therapy, angiotensin receptor blocker and diuretics, was admitted for acute confusion and paresthesia of all four limbs. She had disorientation in time and space, abnormal behavior, decreased muscle strength in both lower limbs (paraparesis 2/5 MRC since the surgery), paresthesia in all four limbs and was unable to walk due to generalized weakness. Laboratory analysis showed high blood levels of cholesterol and glucose. Both head CT and cerebral MRI showed bilateral ischemic changes in the thalami, suggesting an infarct along the artery of Percheron territory. However, no clear cause for the stroke could be identified. Screening for coagulation abnormalities and autoimmune disorders (lupus anticoagulant, anti-beta-2 glycoprotein, anti-cardiolipin, anti-nuclear and anti-ds DNA antibodies) came back negative. There were no pathological finds on the echocardiogram and electrocardiogram, while cervical Doppler ultrasound showed atherosclerosis without stenosis.
Cognitive dysfunction following thalamic stroke: a study of 16 cases and review of the literature
Journal of The Neurological Sciences, 2000
The thalamus is a relay center for afferent sensory pathways that regulates and transmits peripheral stimulation to various representative areas of the cortex. Aphasia, neglect and anosognosia were also reported to occur after thalamic lesions, in the absence of cortical pathology. However, considerable controversy exists as to the pathogenetic mechanisms, and incidence of cognitive abnormalities following thalamic lesions. We present a series of sixteen consecutive stroke patients with thalamic stroke (n512) or hemorrhage (n54), admitted to a university based neurology department. Dysphasia was observed in seven of eight patients with left thalamic strokes (five in the territory of the tuberothalamic artery, two inferior-lateral thalamic lesions and one in the area supplied by the anterior choroidal artery). Neglect and anosognosia appeared in five of eight patients with right side thalamic insults (two each in the territories of the tuberothalamic and thalamogeniculate arteries and one in the area supplied by the posterior choroidal artery). These findings reconfirm those found in previous studies and suggest that the thalamus is part of an integral neuronal network concerned with cognitive functions.
Vascular dementia by thalamic strategic infarct
Arquivos De Neuro-psiquiatria, 2008
Strokes in privileged sites of the cognitive and behavioral circuits constitute strategic infarct vascular dementia (VaD) subtypes (SIVaD) 1-3 . Among such eloquent regions the thalamic nuclei are important targets 3-4 . Such lesions are not common, and those involving thalamus and basal ganglia represent 4.6% of VaD cases 5-6 . These strategic thalamic nuclei play an important integrative role and interconnects with several cortical areas (hippocampal, prefrontal). Amnesia, executive dysfunction and dysphasia are common clinical presentations, besides behavioral and psychological symptoms 6-8 . The thalamic nuclei may be classified in five functional classes and include associative and limbic ones. Branches from the posterior cerebral circulation supply different nuclear groups and intrathalamic tract fibers. The syndromes may be classified considering functional characteristics of the damaged nuclei and the affected vascular territories 9 . Such reports are rare in Brazil, and only two papers were published focusing subcortical structures lesions, including the thalamus.
São Paulo Medical Journal
Context: Ischemia of Percheron’s artery(PA) is a rare neurological occurrence that results in bilateral paramedian thalamic infarction that may affect the midbrain. Among the symptoms are altered mental status, vertical ocular palsy, and memory changes, as well as hemiplegia, cerebellar ataxia, and movement disorders. Objective: To elucidate a case of stroke of the mesencephalic trunk in an uncommon anatomical variant of the thalamus-perfurans arteries Method:Daily neurological and laboratory evaluation in addition to complementary examinations such as skull CT and skull MRI. We also performed a qualitative analysis of articles in Portuguese and English journals indexed in the following databases: PubMed (Public Medical Literature Analysis), Lilacs (Latin American and Caribbean Literature on Health Sciences) and Scielo (Scientific Eletronic Library Online). Case report: A 67 year old male presented with mild to moderate headache for 2 days, reporting chronic cough and decreased leve...
Bilateral thalamus stroke due to percheron artery
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA, 2021
Bilateral thalamus ischemic stroke is a rare condition that carries significant morbidity and mortality in comparison to other forms of stroke. It is usually associated with an anatomical variant with the thalamic paramedian arteries arising from a common trunk from the posterior cerebellar artery, known as Percheron artery. This infarct is difficult to be recognized and early recognition of this syndrome improves survival and functional recovery. We report a case of bilateral thalamic stroke after cardiac surgery.
Frontal dementia related to thalamic stroke: a case report
Neurological Sciences, 2013
The behavioral variant of frontotemporal dementia (bvFTD) is characterized by modifications of personality, social behavior and cognition and relies on a neurodegenerative process . However, vascular lesions affecting subcortical structures, mainly the caudate nucleus and thalamus, may result in a clinical syndrome resembling bvFTD .
Journal of The Neurological Sciences, 2009
The thalami of the human brain obtain their blood supply from many perforating arteries, which exhibit complex distribution and many variations. One rare variation is the artery of Percheron that supplies the paramedian thalami bilaterally. This artery arises from the first segment of the posterior cerebral artery and gives rise to bilateral medial thalamic perforants. Occlusion of the artery of Percheron none rarely results in bilateral thalamic and mesencephalic infarctions. We describe the case of a 38-year-old male patient with a presumed occlusion of this artery in which MR imaging revealed characteristic symmetrical bilateral paramedian thalamic infarctions. The unique characteristics of this case are based on the young age of the patient, the absence of any risk factors or other diseases and even more on the rare clinical manifestations consisted of hypophonia, memory dysfunction, time disorientation and apathy.
Neuropsychology of infarctions in the thalamus: a review
2000
From a review of the literature on the consequences of thalamic infarctions, it may be concluded that memory problems taking the form of an amnesic syndrome are dependent upon the integrity of the mammillo-thalamic tract (MTT). Memory problems incompatible with an amnesic syndrome however, appear to result from thalamic infarctions involving other areas of the thalamus but which leave MTT intact. In contrast, executive dysfunctions could not be shown so readily to depend upon a single structure of the thalamus. The results indicate that damage to the mediodorsal nucleus of the thalamus, the midline nuclei or the intralaminar nuclei, or a combined lesion of these structures may be responsible for de®cits of executive functioning. #
Neuropsychological correlates of a right unilateral lacunar thalamic infarction
1999
Objectives-To report on a patient with a lacunar infarction in the right intralaminar nuclei of the thalamus. The role of the thalamic intralaminar nuclei in cognitive function is as yet insuYciently known. The patient described has shown signs of apathy and loss of initiative, in combination with cognitive deficits, which have persisted essentially unaltered up to the present day since an abrupt onset 17 years ago.
TURKISH JOURNAL OF MEDICAL SCIENCES, 2021
Introduction Thalamus plays a role in many high-level neurological functions, including the transfer of sensory and motor signals to the cerebral cortex, regulation of consciousness, sleep and wakefulness. Classical areas of thalamus are anterior, paramedian, inferolateral and posterior areas [1,2]. However, with the development of imaging methods, it has been reported that there are also variational areas. These areas are 1) Anteromedian region: defined as the infarctions including the posterior of the anterior region and anterior of the paramedian region. 2) Central region: The region which is defined with the inclusion of parts of four adjacent regions in the middle part of the thalamus. 3) Posterolateral region: It is defined as the area connecting the posterior part of the inferolateral region and the anterior of the posterior region. Thalamus is fed by four arteries (polar, thalamoperforating, thalamogeniculate, and posterior choroidal arteries) and the topographic regions of the thalamic infarctions are classically classified according to the watershed area of these four arteries. Variative areas are considered to develop as a result of anatomical variation of these arteries or border zone infarcts [3,4]. Thalamus contains many nuclei, and these nuclei are affected at various rates according to vascular lesions. Patients who admitted to the hospital with thalamus infarction may apply with hemiparesis, hemihypoesthesia, visual field defect, consciousness disorders, sleep disorders, neuropsychiatric findings. Information about the topographic area lesions of the thalamus and their clinical correlations develop after postthalamotomy or with infarction area-clinical finding correlations [5]. Because of the complex nucleus structure and arterial variations, information about thalamus needs to be increased in order Background/aim: Thalamus infarctions presented with various clinical findings are considered to be related to classical and variative infarction areas. In our study, we aimed to compare the sequela clinical findings of patients with isolated thalamus infarction according to anatomical areas. Materials and methods: Seventy patients diagnosed with isolated thalamus infarction in our clinic between 2010 and 2020 were included in the study. The infarction areas of the patients were divided into groups by the radiologist, including the variative areas to the classical areas using magnetic resonance imaging. Neurological examinations were performed and recorded. Sequela clinical findings of the groups were compared. Results: The mean age of all patients was 64.49 ± 13.75 (range between: 33-81) years, and the female ratio was 52.9% (n: 33). Inferolateral area infarction was detected most commonly. The most common complaints were sensory complaints (48.6%), speech disorders (20%), limb weakness (15.7%). There were no significant association between the neurological examination findings of classical and variative area infarctions of patients whose most common admission complaint is sensory deficits (p < 0.05), and significant signs of cognitive impairment were detected in the anterior area compared to other areas (p < 0.001). It can be considered that cognitive impairment we detected in the anterior area developed due to its associations. Conclusion: In our study where sequela findings were evaluated, the absence of a significant difference in neurological examination findings can be explained by the decline of many acute clinical findings over time.