Artery of Percheron Infarction as an Unusual Cause of Coma: Three Cases and Literature Review

Zappella, Nathalie; Merceron, Sybille; Nifle, Chantal; Hilly-Ginoux, Julia; Bruneel, Fabrice; Troché, Gilles; Cordoliani, Yves-Sébastien; Bédos, Jean‐Pierre; Pico, Fernando; Legriel, Stéphane

doi:10.1007/s12028-014-9962-2

Cited by 40 publications

(39 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We also note that most, if not all, cases from the literature describing "thalamic coma" have radiographic evidence of lesions extending into the hypothalamus and brainstem, have exam findings not consistent with the diagnosis of coma, or have clinical signs like ophthalmoplegia that signify damage to the pons or midbrain. [20][21][22] Our findings are also limited in that we focus on level of arousal in the first 12 hours and do not evaluate hypersomnia or circadian rhythm disruptions that have been reported with diencephalic lesions.…”

Section: Discussionmentioning

confidence: 97%

Thalamic strokes that severely impair arousal extend into the brainstem

Hindman

Bowren

Bruss

et al. 2018

Annals of Neurology

View full text Add to dashboard Cite

In this study, we evaluate the role of the thalamus in the neural circuitry of arousal. Level of consciousness within the first 12 hours of a thalamic stroke is assessed with lesion symptom mapping. Impaired arousal correlates with lesions in the paramedian posterior thalamus near the centromedian and parafascicular nuclei, posterior hypothalamus, and midbrain tegmentum. All patients with severely impaired arousal (coma, stupor) had lesion extension into the midbrain and/or pontine tegmentum, whereas purely thalamic lesions did not severely impair arousal. These results are consistent with growing evidence that pathways most critical for human arousal lie outside the thalamus.

show abstract

Section: Discussionmentioning

confidence: 97%

Thalamic strokes that severely impair arousal extend into the brainstem

Hindman

Bowren

Bruss

et al. 2018

Annals of Neurology

View full text Add to dashboard Cite

show abstract

“…In our study, we noted that it was only 4 of 9 in patients with bilateral infarcts, and 8 of 12 in patients with unilateral paramedian thalamic infarcts, but selective gaze palsy was not recorded. It was reported that 39.2-60% patients with bithalamic paramedian infarcts had memory impairment [12,13]. Only 1 patient with bilateral paramedian thalamic lesion in our cases complained of memory impairment, while 3 patients with unilateral lesions showed memory impairment.…”

Section: Discussionmentioning

confidence: 41%

“…Zappella et al [12] reported that 49 of 120 patients with bilateral thalamic paramedian infarcts had coma but it resolved rapidly (who persisted 2-8 days coma duration). It was quite congruent with our results.…”

Section: Discussionmentioning

confidence: 99%

Paramedian Thalamic Ischemic Infarction: A Retrospective Clinical Observation

Lin¹,

Zhang

et al. 2017

Eur Neurol

View full text Add to dashboard Cite

Background: The study aimed to evaluate the clinical features in patients with bilateral and unilateral paramedian thalamic infarcts. Methods: Twenty-one patients with paramedian thalamic infarcts were included, and their case records were reviewed. We focused on the patients' neuroimaging and neurological symptoms including the duration of coma, vertical gaze palsy, and memory impairment. The causes of bilateral and unilateral paramedian thalamic infarcts were also investigated. Result: Nine patients had bilateral paramedian thalamic infarcts and 12 patients had unilateral lesions. As an initial symptom, coma had occurred in 5 patients with bilateral lesions and 4 patients with unilateral lesions. Bilateral vertical gaze palsy and memory impairment were found in both groups. Most of them recovered well, except 1 patient who died due to bilateral thalamic paramedian infarction. Conclusions: Our results show that both bilateral and unilateral paramedian thalamic infarcts can cause coma, vertical gaze palsy, and memory impairment. This may promote our understanding of paramedian thalamic infarction.

show abstract

“…La oclusión de dicha arteria provoca infarto talámico paramedial bilateral sin o con afectación mesencefálica. 4,5 Comunicamos el caso de una paciente mujer de 49 años con factores de riesgo cardiovascular, que fue llevada al servicio de urgencias por presentar mareos y alteración súbita de la conciencia. Las pruebas complementarias de rutina fueron normales.…”

Section: Estimados Editoresunclassified

“…La angiografía no siempre es necesaria para el diagnóstico y resulta útil cuando los métodos anteriores no son concluyentes, o bien, para fines terapéuticos específicos. 2, [4][5][6]8 Otros diagnósticos diferenciales del infarto de la arteria de Percheron son: encefalopatía de Wernicke, mielinolisis extrapontina, encefalitis viral, enfermedad de Wilson, gliomas, enfermedad de Creutzfeldt-Jakob, aunque las lesiones no siguen un territorio vascular conocido. 6,8 El tratamiento suele ser de soporte, idealmente en una unidad de cuidados intensivos, ya que los pacientes presentan menor morbimortalidad.…”

Section: Estimados Editoresunclassified