摘要
Bilateral thalamic infarcts have a low frequency among different subtypes of strokes.Since it does not involve a particular vascular territory,it therefore usually involves the occlusion of the artery of Percheron(AOP).Here we report a 79-year-old right-handed Parkinsonian female patient,who was found unresponsive in bed.On examination,the patient was drowsy with a Glasgow Coma Score(GCS)of 10/15(E2M5V3).She had absent doll’s eye response with anisocoric pupils and intermittent vertical gaze palsy.Although the patient had no apparent motor deficits,she was in a state of persistent somnolence with memory impairment and lack of initiative.Diffusion-weighted magnetic resonance imaging(MRI)of the brain showed focal areas of restricted diffusion in the medial part of the thalami bilaterally and the rostral part of mid-brain(right>left)(bilateral paramedian thalamic with mid-brain pattern),suggestive of a hyper-acute infarct in the territory of AOP.The patient was anticoagulated with 40 mg subcutaneous low molecular weight heparin and was started on double anti-platelets along with supportive measures.The level of consciousness is improved at a slow rate to a GCS of 12/15(E4M5V3).The patient had marked abulia with periods of drowsiness interspersed with periods of restlessness and uttering of abnormal sounds,but she was able to execute simple commands.In conclusion,occlusion of the AOP is a rare cause of coma in elderly patients.Diffusion-weighted MRI is the imaging modality of choice for early diagnosis.Early diagnosis of AOP occlusion may lead to favorable outcomes.
