Acute bithalamic infarct manifesting as sleep-like coma: A diagnostic challenge

Honig, Asaf; Eliahou, Ruth; Eichel, Roni; Shemesh, Ari; Ben‐Hur, Tamir; Auriel, Eitan

doi:10.1016/j.jocn.2016.05.014

Cited by 18 publications

(17 citation statements)

References 12 publications

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“…Cette hétérogénéité clinique s'explique par la complexité vasculaire et physiologique du noyau thalamique. Des cas similaires étaient rapportés dans la littérature par Agarwal et al, Caruso et al, et, Honig et al [6][7][8]. Dans notre série, la symptomatologie clinique était marquée par des troubles de la vigilance avec coma, des troubles moteurs avec tétra parésie, des troubles confusionnels et mnésiques, et, des troubles visuels.…”

Section: Original Articleunclassified

“…Dans notre série, la symptomatologie clinique était marquée par des troubles de la vigilance avec coma, des troubles moteurs avec tétra parésie, des troubles confusionnels et mnésiques, et, des troubles visuels. Tous ces signes cliniques observés dans notre série ont été décrits dans la littérature [8,9]. En effet, selon Lövblad et al, Weidauer et al, à cause de la vascularisation complexe du noyau thalamique, les lésions sur IRM et les manifestations cliniques sont hétérogènes en cas d'ischémie [5,9].…”

Section: Original Articleunclassified

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Thrombolyse intraveineuse dans l’infarctus cérébral du territoire de l’artère de Percheron

Anayo¹,

Bouchenek²,

P³

et al. 2021

Swiss Arch Neurol Psychiatr Psychother

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Intravenous thrombolysis for a cerebral infarct in the artery of Percheron areaThe artery of Percheron (AP) or type IIb is an anatomical variant corresponding to a unique arterial trunk that vascularises both the thalami and the midbrain. Occlusion of the AP, although rare, causes bithalamic infarcts characterised by acute polymorphic neurological symptoms, which are often dangerous and include coma necessitating resuscitation. Magnetic resonance imaging (MRI) diffusion weighted imaging (DWI) allows a quick positive diagnosis. Intravenous thrombolysis (IVT), if administered, helps to improve the neurological prognosis.We report a series of cases of bilateral thalamic infarcts from 2014 to 2019 caused by occlusion of the AP with immediate coma, thrombolysed with intravenous recombinant tissue plasminogen activator. Fast amelioration of neurological function and at 3-month follow-up was spectacular; the patients had no additional deficit. In all cases of "coma", it is essential to perform MRI-DWI quickly in order to diagnose a brain infarct caused by occlusion of the AP, in which the prognosis seems to be improved by IVT.

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Section: Original Articleunclassified

Thrombolyse intraveineuse dans l’infarctus cérébral du territoire de l’artère de Percheron

Anayo¹,

Bouchenek²,

P³

et al. 2021

Swiss Arch Neurol Psychiatr Psychother

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Section: Casementioning

confidence: 99%

“…The wide range sensorium impairment ranging from hypersomnia to coma secondary to bilateral thalamic infarction usually leads to diagnostic confusion among physicians . Many physicians might not consider stroke due to the lack of focal neurological deficit . In suspected cases, diagnosis can be made earlier with diffusion‐weighted (DW)‐MRI, this will lead to earlier intervention which in turn reduce the risk of deep coma due to involvement of the rostral midbrain and long‐term cognitive dysfunction including thalamic dementia .…”

Section: Casementioning

confidence: 99%

“…Many physicians might not consider stroke due to the lack of focal neurological deficit . In suspected cases, diagnosis can be made earlier with diffusion‐weighted (DW)‐MRI, this will lead to earlier intervention which in turn reduce the risk of deep coma due to involvement of the rostral midbrain and long‐term cognitive dysfunction including thalamic dementia . Ironically, in a context in which time equals neuron, thrombolysis is rarely reported for thalamic infarction in the literature .…”

Section: Casementioning

confidence: 99%

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