Hospital: Hospital Universitario San Cecilio.
Aut@r o Autores: M. Revelles Paniza, P. Pérez Naranjo, C. Martinez Martinez.
We present a case of a 75-year-old patient who came to the Emergency Department with disorientation and blurred vision. A cranial CT is requested, where bilateral thalamic hypodensity is observed, more evident in a CT scan performed after 24 hours. The patient is admitted to the Neurology service with the clinical suspicion of infarction of the Percheron artery. In the MRI performed on the patient during admission, the existence of bilateral thalamic infarction was confirmed.
The Percheron paramedian artery (also called the Duret internal optic artery or thalamus-perforating artery of Foix and Hillerman) is an uncommon variant, where a single thalamic-perforating artery supplies both thalamic nuclei, with variable irrigation of the mesencephalon. When an ischemic condition depends on the Percheron's artery, the neurological manifestations that usually appear are the fluctuating affectation of the level of consciousness, including coma, language impairment, as well as altered mood, cranial oculomotor involvement, movement disorders and memory impairment.
This case confirms the importance of knowing anatomical variations in thalamic and mesencephalic irrigation as well as recognizing bilateral thalamic ischemic in CT and MRI studies. MRI is essential to confirm the existence of ischemia of both thalamic nuclei.
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