Artery of percheron infarct - a rare thalamic stroke

Abstract

Thalamic infarcts can occur in about 15
of all stroke patients mostly presenting
as sensory disturbances in one half of
the body with or without hemiparesis.
Large thalamic infarcts causing coma
and mortality are rare. We report a rare
case of stroke in young presenting as
coma initially and subsequently found to
have bilateral medial thalamic infarct due
to Artery of Percheron occlusion on MRI
of the brain. A 28 year old male, nonhypertensive,
non- diabetic with no prior
heart disease admitted in medical ward
with altered sensorium for few hours with
no previous episodes or illness. On examination
he had no focal deficit except
for altered sensorium. Even though there
are numerous causes for coma, early imaging
in this patient revealed the cause
of coma as stroke due to bilateral thalamic
infarct. The patient regained the
consciousness one day later and found
to have other features of bilateral thalamic
infarct such as vertical gaze palsy,
loss of accommodation , memory disturbances
. On further investigations he
was confirmed to have artery of
percheron infarct as well as
hyperhomocysteinemia.The patient improved
in about a week and discharged
with recent memory disturbance and vertical
gaze palsy. This patient is presented for
the rare cause of strokehyperhomocysteinemia
with thalamic artery
of percheron infarct and emphasized the
need for early imaging.