Ikramuddin Salman S, Coburn John A, Ramezani Solmaz, Streib Christopher
Department of Neurology (SSI, SR, CS), University of Minnesota, Minneapolis; and Midwest Radiology (JAC), Roseville, MN.
Neurol Clin Pract. 2024 Apr;14(2):e200266. doi: 10.1212/CPJ.0000000000200266. Epub 2024 Feb 15.
Occlusion of the artery of Percheron (AOP) produces bilateral thalamic infarction classically leading to deficits of arousal. This nonspecific presentation complicates the diagnosis of acute ischemic stroke. We sought to describe the spectrum of clinical presentation, diagnostic neuroimaging findings, and outcomes in AOP infarction (AOPi).
We conducted a keyword search of our health system's neuroimaging database from 2014 to 2022 to identify patients with AOPi. We abstracted patient demographics, clinical presentation, neuroimaging findings, acute treatment, and modified Rankin Scale (mRS) scores (at baseline, 3 months, and 12 months). We used descriptive statistics to report our findings.
Our initial keyword search identified 192 potential AOPi cases. Fifteen cases of AOPi were confirmed and included in our study (8 female [53%], median age 65 years [interquartile range (IQR): 59.5-79.5], median presenting NIHSS 6 [IQR: 2-22]). Common clinical findings on presentation were systolic blood pressure (SBP) > 140: 12 patients (80%); decreased level of consciousness (LOC): 11 patients (73%); diplopia: 8 patients (57%); disorientation: 6 patients (42%); dysarthria: 4 patients (28%); and acute memory/cognitive disturbance: 3 patients (21%). Twelve cases (80%) presented to the emergency department (ED). Median time from symptom onset to ED arrival was 774.5 minutes (IQR: 202.25-3789.0), 4 cases (27%) arrived within 4.5 hours, and one patient (7%) received intravenous thrombolysis. The median time from ED arrival to stroke diagnosis was 519.0 minutes (IQR: 227.5-1307). Head CT was only diagnostic when obtained >570 minutes from time last known well; MRI was diagnostic at all time points. Rates of functional independence (mRS ≤2) at baseline, 3 months, and 12 months were 64%, 21%, and 18%, respectively.
The diagnosis of stroke was considerably delayed in patients with AOPi, and only one patient received IV thrombolysis. SBP >140, impaired consciousness, and diplopia were the most common findings at presentation. CT was often nondiagnostic, but MRI demonstrated bilateral thalamic infarct in all cases. AOPi caused considerable long-term morbidity. Clinicians should maintain a high degree of suspicion for AOP stroke and consider thrombolysis in appropriately selected patients.
大脑后动脉丘脑穿通动脉（AOP）闭塞可导致双侧丘脑梗死，典型表现为觉醒功能障碍。这种非特异性表现使急性缺血性卒中的诊断变得复杂。我们试图描述AOP梗死（AOPi）的临床表现谱、诊断性神经影像学表现及预后。
我们对2014年至2022年我们医疗系统的神经影像学数据库进行关键词搜索，以识别AOPi患者。我们提取了患者的人口统计学信息、临床表现、神经影像学表现、急性治疗情况及改良Rankin量表（mRS）评分（基线、3个月和12个月时）。我们使用描述性统计方法报告研究结果。
我们最初的关键词搜索识别出192例潜在的AOPi病例。15例AOPi病例得到确诊并纳入我们的研究（8例女性[53%]，中位年龄65岁[四分位间距（IQR）：59.5 - 79.5]，入院时美国国立卫生研究院卒中量表（NIHSS）中位评分6分[IQR：2 - 22]）。就诊时的常见临床表现为收缩压（SBP）>140：12例患者（80%）；意识水平下降（LOC）：11例患者（73%）；复视：8例患者（57%）；定向障碍：6例患者（42%）；构音障碍：4例患者（28%）；急性记忆/认知障碍：3例患者（21%）。12例患者（80%）前往急诊科（ED）就诊。从症状发作到抵达ED的中位时间为774.5分钟（IQR：202.25 - 3789.0），4例患者（27%）在4.5小时内抵达，1例患者（7%）接受了静脉溶栓治疗。从抵达ED到卒中诊断的中位时间为519.0分钟（IQR：227.5 - 1307）。仅在距最后一次已知正常时间>570分钟时进行的头部CT才有诊断价值；MRI在所有时间点均有诊断价值。基线、3个月和12个月时功能独立（mRS≤2）的比例分别为64%、21%和18%。
AOPi患者的卒中诊断明显延迟，仅有1例患者接受了静脉溶栓治疗。就诊时SBP>140、意识障碍和复视是最常见的表现。CT常无诊断价值，但MRI在所有病例中均显示双侧丘脑梗死。AOPi导致了相当程度的长期致残。临床医生应高度怀疑AOP卒中，并在适当选择的患者中考虑溶栓治疗。
