National Hospital of Sri Lanka, Colombo, Sri Lanka.
BMC Neurol. 2020 Aug 28;20(1):320. doi: 10.1186/s12883-020-01889-9.
Thalamic blood supply consists of four major vascular territories. Out of them paramedian arteries supply ipsilateral paramedian thalami and occasionally rostral mid brain. Rarely both paramedian arteries arise from a common trunk that arise from P1 segment of one sided posterior cerebral artery (PCA). This is usually due to hypoplastic or absent other P1 and this common trunk is termed Artery of Percheron (AOP). Its prevalence is in the range of 7-11% among the general population and AOP infarcts account in an average of 0.4-0.5% of ischemic strokes. Clinical presentation of AOP infarction is characterized by impaired arousal and memory, language impairment and vertical gaze palsy. It also can present with cerebellar signs, hemi paresis and hemi sensory loss. We herein present a case of AOP infarction presenting as transient loss of consciousness and nuclear third nerve palsy.
A 51 year old previously healthy male, was brought to us, with a Glasgow coma scale (GCS) of 7/15. GCS improved to 11/15 by the next day, however he had a persisting expressive aphasia. Right sided nuclear third nerve palsy was apparent with the improvement of GCS. He did not have pyramidal or cerebellar signs. Thrombolysis was not offered as the therapeutic window was exceeded by the time of diagnosis. Diagnosis was made using magnetic resonance imaging (MRI) that was done after the initial normal non-contrast computer tomography (NCCT) brain. He was enrolled in stroke rehabilitation. Aspirin and atorvastatin was started for the secondary prevention of stroke. He achieved independency of advanced daily living by 1 month, however could not achieve full recovery to be employed as a taxi driver.
Because of the rarity and varied clinical presentation with altered levels of consciousness, AOP infarcts are easily overlooked as a stroke leading to delayed diagnosis. Timely diagnosis can prevent unnecessary investigations and the patient will be benefitted by early revascularization. As it is seldom reported, case reports remain a valuable source of improving awareness among physicians about this clinical entity.
丘脑的血液供应由四个主要的血管区域组成。其中，旁正中动脉供应同侧旁正中丘脑，偶尔也供应颅前脑中部。很少有两条旁正中动脉来自单侧大脑后动脉（PCA）P1 段的共同干。这通常是由于其他 P1 段发育不良或缺失，而这条共同干被称为 Percheron 动脉（AOP）。在普通人群中，其患病率在 7-11%之间，AOP 梗死占缺血性中风的平均 0.4-0.5%。AOP 梗死的临床表现为觉醒和记忆障碍、语言障碍和垂直凝视麻痹。它也可以表现出小脑征、偏瘫和半身感觉丧失。本文报告了一例以短暂性意识丧失和核性第三对脑神经麻痹为表现的 AOP 梗死病例。
一名 51 岁的既往健康男性，格拉斯哥昏迷量表（GCS）评分为 7/15，被送到我们这里。第二天，GCS 改善至 11/15，但他仍有持续的表达性失语症。右侧核性第三对脑神经麻痹在 GCS 改善时明显。他没有锥体束或小脑征。由于诊断时已超过治疗窗，未进行溶栓治疗。诊断是在初始正常非对比计算机断层扫描（NCCT）脑后使用磁共振成像（MRI）做出的。他被纳入中风康复治疗。为了二级预防中风，开始使用阿司匹林和阿托伐他汀。他在 1 个月内达到了高级日常生活的独立性，但无法完全康复以从事出租车司机工作。
由于其罕见性和不同的临床表现，伴有意识水平改变，AOP 梗死很容易被忽视为导致诊断延迟的中风。及时诊断可以防止不必要的检查，患者将通过早期血管再通获益。由于很少有报道，病例报告仍然是提高医生对这一临床实体认识的宝贵资源。
