Monet P, Garcia P-Y, Saliou G, Spagnolo S, Desblache J, Franc J, Vallée J-N, Deramond H, Lehmann P
Service de neuroradiologie, CHU d'Amiens, 1 Place Victor-Pauchet, 80054 Amiens Cedex 1, France.
Rev Neurol (Paris). 2009 Feb;165(2):178-84. doi: 10.1016/j.neurol.2008.08.012. Epub 2008 Nov 12.
Bithalamic paramedian infarcts are uncommon. This stroke results in a complex clinical syndrome.
We report four cases of bithalamic paramedian infarcts with a presumed mechanism of occlusion of a single thalamic paramedian artery.
This normal anatomic variant corresponds to an asymmetrical common trunk for the two thalamosubthalamic paramedian arteries arising from a P1 segment (type IIb in the G. Percheron classification dating from 1977). A literature analysis (from 1985 to 2006) allowed us to identify the most widely reported clinical signs. Four main clinical findings are described: vertical gaze palsy (65%), memory impairment (58%), confusion (53%) and coma (42%). We also found these symptoms in our patients but rarely associated; however, all four patients had exhibited episodes of drowsiness. In this article, we discuss the anatomy-function correlation responsible for such clinical variability.
Clinicians should be aware of this diagnosis to better understand the imaging results which provide confirmation. Although the literature describes frequently severe consciousness disorders such as coma, this diagnosis must also be considered in patients presenting a simple fluctuation of consciousness, e.g. hypersomnia.
双侧丘脑旁正中梗死并不常见。这种中风会导致复杂的临床综合征。
我们报告了4例双侧丘脑旁正中梗死病例，推测其机制为单一丘脑旁正中动脉闭塞。
这种正常的解剖变异对应于源自P1段的两条丘脑底丘脑旁正中动脉的不对称共同主干（在1977年的G.佩谢龙分类中为IIb型）。一项文献分析（1985年至2006年）使我们能够确定最常报道的临床体征。描述了四项主要临床发现：垂直凝视麻痹（65%）、记忆障碍（58%）、意识模糊（53%）和昏迷（42%）。我们在患者中也发现了这些症状，但很少同时出现；然而，所有4例患者均有嗜睡发作。在本文中，我们讨论了导致这种临床变异性的解剖-功能相关性。
临床医生应了解这一诊断，以便更好地理解提供确诊依据的影像学结果。尽管文献中经常描述昏迷等严重意识障碍，但对于出现意识简单波动（如嗜睡）的患者也必须考虑这一诊断。
