Hammersley Daniel, Arora Ankur, Dissanayake Madhava, Sengupta Nabarun
Cardiology Department, Western Sussex Hospitals NHS Trust, Worthing, UK.
Radiology Department, Western Sussex Hospitals NHS Trust, Worthing, UK.
BMJ Case Rep. 2017 Jan 2;2017:bcr2016218035. doi: 10.1136/bcr-2016-218035.
An 81-year-old man underwent cardiac catheterisation to investigate breathlessness and left ventricular impairment of unknown cause. He had unobstructed coronary arteries. Immediately following the procedure, he became suddenly unresponsive with vertical gaze palsy, anisocoria and bilateral upgoing plantar responses. He made a rapid recovery to his premorbid state 25 min later with no residual focal neurological signs. He then had multiple unresponsive episodes, interspaced with complete resolution of symptoms and neurological signs. MRI of the brain identified bilateral medial thalamic infarcts and midbrain infarcts, consistent with an artery of Percheron territory infarction. By the time the diagnosis was reached, the thrombolysis window had elapsed. The unresponsive episodes diminished with time and the patient was discharged to inpatient rehabilitation. At 6-month review after the episode, the patient has a degree of progressive cognitive impairment.
一名81岁男性因不明原因的呼吸困难和左心室功能障碍接受了心导管检查。他的冠状动脉没有阻塞。手术后立即出现突然无反应，伴有垂直凝视麻痹、瞳孔不等大和双侧巴宾斯基征阳性。25分钟后，他迅速恢复到病前状态，没有残留的局灶性神经体征。随后他又多次出现无反应发作，症状和神经体征完全缓解。脑部MRI显示双侧内侧丘脑梗死和中脑梗死，符合大脑后动脉丘脑穿通动脉供血区梗死。在做出诊断时，溶栓窗已经过去。随着时间的推移，无反应发作减少，患者出院接受住院康复治疗。发作后6个月复查时，患者有一定程度的进行性认知障碍。
