A Case of Bilateral Thalamic Infarcts Involving the Artery of Percheron in the Setting of COVID-19

Wilson, Branden; Srinivasan, Aswin; Pansuriya, Tusharkumar; Alim, Salman; Ali, Uzma

doi:10.7759/cureus.15587

Cited by 2 publications

(3 citation statements)

References 14 publications

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“…They also reported a high proportion of large vessel occlusion (33%) whereas small vessel occlusion and lacunar strokes were rare (10%) [4]. Recent studies show cryptogenic cause for stroke in COVID-19-positive patients suggesting an association of stroke with COVID infection [5]. The possible mechanism of stroke in COVID-19 patients is attributed to hypercoagulability, endothelial damage, and excessive cytokine release.…”

Section: Discussionmentioning

confidence: 99%

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Encephalitis or Stroke? A Case Report of Thalamic Stroke in COVID Era

Damodaran¹,

Koutaich²,

Nayak³

et al. 2022

Dubai Med J

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Introduction: Since 2019, COVID-19 pneumonia caused by SARS-CoV-2 virus has led to a worldwide pandemic. Since then, various neurological manifestations of COVID-19 pneumonia have been reported. Neurological manifestations include headache, anosmia, seizures, and altered mental status. In some cases, it presents as stroke, encephalitis, and neuropathy. Artery of Percheron (AOP) is a variant in the posterior circulation. Here, a single artery arises from the posterior cerebral artery p1 segment. It supplies bilateral thalamus with or without midbrain. Thrombosis in this artery leads to clinical symptoms like reduced level of consciousness, altered mental status, and memory impairment. Case Report: Here, we present a case who presented with fever and altered sensorium without any focal neurological deficits and without known risk factors for stroke. His COVID-19 PCR was positive. He was initially diagnosed as COVID-19 pneumonia with encephalitis and was started on treatment for the same. His initial CT brain and lumbar puncture were normal. The next day, when MRI brain with and without contrast was done, the thalamic stroke due to AOP infarction was diagnosed and appropriate treatment for stroke was initiated. Discussion: Many patients miss the window for thrombolysis because of variable presentation in clinical symptoms with negative imaging. It is also difficult to assess the time of onset of stroke in this varied presentation. Our patient had fever and cough for 2 days and had altered mental status since the morning of admission. During hospital stay, he developed bilateral third nerve palsy. This case also highlights the importance of detailed evaluation in COVID-19 patients with neurological complaints. This helps to avoid delays in treatment and to improve clinical outcomes. As our knowledge of COVID-19 and its varied neurological manifestations evolve, we need to be prepared for more atypical presentation to facilitate timely interventions.

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Section: Discussionmentioning

confidence: 99%

“…Branden et al [5] reported a similar case of AOP infarct with COVID-19 infection and their patient presented with right-sided weakness and third nerve palsy at the onset and was thrombolyzed. In contrast, when our patient first presented, the diagnosis was missed since there was no localized neurological abnormality.…”

Section: Discussionmentioning

confidence: 99%

Encephalitis or Stroke? A Case Report of Thalamic Stroke in COVID Era

Damodaran¹,

Koutaich²,

Nayak³

et al. 2022

Dubai Med J

View full text Add to dashboard Cite

show abstract

“…In both instances, the patients were discharged with a favorable mRS. The patient in Wilson et al's case 19 underwent thrombolytic therapy, while Pantovic et al's case 20 was managed with intrahospital anticoagulation due to the COVID-19 diagnosis. The etiology of the infarction in one patient was attributed to a PFO.…”

Section: Special Casesmentioning

confidence: 99%

Diagnostic challenges in bilateral thalamic infarction: national series of cases

Amaya,

Jimenez,

Moreno-Vargas

et al. 2024

RMN

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Objective: To describe the acute care of patients with bilateral thalamic infarctions in primary and advanced stroke centers in different regions of Colombia. Methods: Multicenter retrospective descriptive study of a series of cases of patients with an imaging diagnosis of bilateral thalamic infarction, in Colombia. 14 hospitals located in seven cities of the country participated. Results: 28 cases were registered, the mean age was 66.8 years with 53.6% men and 96.3% had a favorable previous mRs (0-2). Mean NIHSS at admission was 14 points, the most frequent clinical presentation was altered mental status in 82.1%. The most compromised structure was the bilateral anterior region of the thalamus in 12 patients (42.85%). The most common etiology was undetermined cause (39.3%). 1 patient underwent reperfusion therapy with intravenous thrombolysis (3.6%). Mean hospital stay was 19 days. Conclusions: Bilateral thalamic infarcts are a diagnostic challenge in the emergency department, due to their low reported incidence and the variable clinical presentations, stroke and research centers should be strengthened to contribute to clinical outcomes.

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A Case of Bilateral Thalamic Infarcts Involving the Artery of Percheron in the Setting of COVID-19

Abstract: Wilson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 2 publications

References 14 publications

Encephalitis or Stroke? A Case Report of Thalamic Stroke in COVID Era

Encephalitis or Stroke? A Case Report of Thalamic Stroke in COVID Era

Diagnostic challenges in bilateral thalamic infarction: national series of cases

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