Navickaitė Milda, Vilionskis Aleksandras, Dapkutė Austėja, Ryliškienė Kristina
Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Acta Med Litu. 2025;32(1):145-152. doi: 10.15388/Amed.2025.32.1.14. Epub 2025 Feb 18.
The (AOP) is a vascular variant supplying both sides of the thalamus, present in up to one-quarter of the general population. AOP occlusion is a rare cause of ischemic stroke, resulting in bilateral thalamic infarction. It typically manifests as altered consciousness, gaze abnormalities, and cognitive impairment. Neuroimaging of AOP stroke is challenging, as head CT is often unremarkable. However, a diagnostic 'V' sign can be identified on MRI. AOP stroke is treated as other types of ischemic stroke.
We present a case of a 61-year-old male with a history of alcohol abuse, diagnosed with ischemic AOP stroke. He presented with sudden loss of consciousness, third nerve palsy, and vertical gaze palsy. MRI revealed bilateral paramedian thalamic infarction with midbrain involvement. Despite conservative treatment, his condition showed minimal improvement, leaving him lethargic and dysarthric. He was discharged to palliative care after two weeks.
AOP infarction, though rare, should be considered in patients with altered consciousness. Early MRI is essential for accurate diagnosis and timely treatment, highlighting the importance of physician awareness of this condition.
前交通动脉（AOP）是一种为丘脑两侧供血的血管变异，在普通人群中发生率高达四分之一。前交通动脉闭塞是缺血性卒中的罕见病因，可导致双侧丘脑梗死。其典型表现为意识改变、凝视异常和认知障碍。前交通动脉卒中的神经影像学检查具有挑战性，因为头部CT通常无明显异常。然而，在磁共振成像（MRI）上可发现诊断性的“V”征。前交通动脉卒中的治疗与其他类型的缺血性卒中相同。
我们报告一例61岁有酗酒史的男性，诊断为缺血性前交通动脉卒中。他表现为突发意识丧失、动眼神经麻痹和垂直凝视麻痹。MRI显示双侧丘脑旁正中梗死并累及中脑。尽管进行了保守治疗，他的病情改善甚微，仍嗜睡且构音障碍。两周后他出院接受姑息治疗。
前交通动脉梗死虽罕见，但对于意识改变的患者应予以考虑。早期MRI对于准确诊断和及时治疗至关重要，这凸显了医生对该疾病认识的重要性。
