Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation.
Department of Emergency, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation.
J Nippon Med Sch. 2021;88(4):375-379. doi: 10.1272/jnms.JNMS.2021_88-414.
The artery of Percheron (AOP) is an anatomical variant of the thalamoperforating arteries. AOP occlusion can cause bilateral paramedian thalamic infarctions and is referred to as a "stroke chameleon" because it lacks the classic signs of stroke. Coexistence of AOP occlusion and other neurologic disease is rare and can cause disturbance of consciousness. A 78-year-old woman had acute onset of left limb weakness and drowsy consciousness. Brain magnetic resonance angiography (MRA) revealed acute bilateral paramedian thalamic infarctions. However, serum and cerebrospinal fluid (CSF) cryptococcal antigen titers were 1:16 and 1:128, respectively. The CSF culture grew Cryptococcus neoformans. Although consciousness and muscle power improved after treatment, the patient later died of pneumonia. A 68-year-old woman developed acute disturbance of consciousness followed by delirium. Brain MRA revealed acute bilateral paramedian thalamic infarctions. Elevated free thyroxine, anti-thyroperoxidase, and anti-thyroglobulin antibodies were detected. She received 3 days of steroid pulse therapy followed by oral prednisolone. Her consciousness gradually improved after Hashimoto encephalopathy and stroke were controlled. AOP occlusion was diagnosed early in these two patients. However, other concomitant life-threatening diseases could have been overlooked because of the complicated diagnostic determination. Further serum cryptococcal antigen, anti-TPO Ab, and anti-TG Ab surveys might help to exclude cryptococcal meningitis and Hashimoto encephalopathy. CSF study is warranted when central nervous system infection is strongly suspected. This "Percheron artery-plus syndrome" comprises multifaceted disorders beyond the stroke chameleon and requires attention.
Percheron 动脉（AOP）是穿通动脉的一种解剖变异。AOP 闭塞可导致双侧旁正中丘脑梗死，被称为“中风变色龙”，因为它缺乏中风的典型体征。AOP 闭塞与其他神经系统疾病共存较为罕见，可引起意识障碍。一位 78 岁女性突发左侧肢体无力和嗜睡意识障碍。脑磁共振血管造影（MRA）显示急性双侧旁正中丘脑梗死。然而，血清和脑脊液（CSF）隐球菌抗原滴度分别为 1:16 和 1:128，CSF 培养出新型隐球菌。尽管经过治疗后意识和肌力有所改善，但患者后来死于肺炎。一位 68 岁女性突发意识障碍，随后出现谵妄。脑 MRA 显示急性双侧旁正中丘脑梗死。检测到游离甲状腺素、抗甲状腺过氧化物酶和抗甲状腺球蛋白抗体升高。她接受了 3 天的类固醇脉冲治疗，随后口服泼尼松。在控制桥本脑病和中风后，她的意识逐渐改善。这两名患者均早期诊断出 AOP 闭塞。然而，由于诊断判断复杂，其他并发的危及生命的疾病可能被忽视。进一步的血清隐球菌抗原、抗 TPO Ab 和抗 TG Ab 检测可能有助于排除隐球菌性脑膜炎和桥本脑病。当强烈怀疑中枢神经系统感染时，需要进行脑脊液研究。这种“Percheron 动脉+综合征”包括中风变色龙之外的多方面疾病，需要关注。
