Presentation
Symptoms started 3 days ago with difficulty of finding words, decreased consciousness and vertical gaze palsy. No lateralization, no headache.
Patient Data
Bilateral hypodense aspect of the medial thalamus, suggesting subacute ischemia caused by occlusion of the artery of Percheron. No signs of cerebral venous thrombosis. No dense aspect of the basilar artery.
Good patency of the anterior and the posterior cerebral circulation, with specific attention to the basilar artery and the P1-segment of the posterior cerebral arteries. No thrombi or emboli.
Diffusion/Flair/T2 confirms two acute to semi-acute ischemic lesions in the medial thalami.
Note the pronounced periventricular white-matter lesions suggesting chronic microvascular ischemic disease.
Case Discussion
This is a case of bilateral thalamic infarction can be caused by an occlusion of the artery of Percheron. This uncommon anatomical variant describes a single dominant artery, arising from the P1 artery, supplying both the medial thalami instead of bilateral blood supply.
This patient did not have associated midbrain infarction, however, if associated with midbrain infarction, the prognosis is worse.
Other possible causes of bilateral thalamic infarction are cerebral venous thrombosis and top of the basilar syndrome, which need to be excluded as a cause.
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