Bilateral thalamic infarction
A known diabetic and hypertensive patient had become unconscious while at work. Initial GCS was 9/15 which improved up to 12/15 and remained static. There was no limb weakness. There was no fever and white cell counts were normal.
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Bilateral thalami were hypointense in T1, hyperintense in T2 & FLAIR, and with diffusion restriction. There was no extension to the midbrain. No mass effect was seen. Both MRA & MRV were unremarkable.
Lentiform nuclei, mammillary bodies and periaqueductal regions did not show any signal change.
The artery of Percheron is a rare anatomical variant of the posterior circulation where, instead of two parasagittal arteries, there is only one trunk arising from either of the proximal posterior cerebral arteries, supplying both thalami and rostral midbrain. Occlusion of this single artery leads to bilateral thalamic infarcts. These patients may be presented in comatose or agitated states with hemiplegia or hemisensory loss. The CT and MRI findings show bilateral thalamic infarcts sometimes with mesencephalic extension.
Authors: Aruna Pallewatte, Iddamali Kariyawasam
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