CASE 15968 Published on 03.11.2018

What does it happen when an unlucky patient has an oclusion of the posterior cerebral artery?

Section

Neuroradiology

Case Type

Clinical Cases

Authors

Monica Fdez. del Castillo Ascanio, Laura Cabrera Romero, Vicente Martín García

HUNSC,Emergency Radiology; C/Ruben Marichal Lopez, Nº 44, 19-A 38004 Santa Cruz de Tenerife, Spain; Email:esp272@gmail.com
Patient

67 years, male

Categories
Area of Interest Neuroradiology brain, Emergency, Education ; Imaging Technique CT-Angiography, CT
Clinical History
63-year-old male found at home in coma. The neurology service activated him as a stroke code. CT was performed without relevant findings and angio-CT showed occlusion of the left posterior cerebral artery. Mechanical thrombectomy was successfully performed but a new CT scan was performed after 48 h showing ischemic lesions.
Imaging Findings
Figure 1. Simple CT without relevant findings
Figure 2. Angio- TC (coronal (a) and axial (b) reconstructions) showing an occlusion of the left cerebral artery
Figure 3. a, Mesencephalic and posterior cerebral artery ischemic lesions. b, Bilateral thalamic ischemic lesions
Discussion
In a coma patient with an occlusion of the posterior cerebral artery treated early, we must consider the possibility of an anatomical variant as in our case. In view of the appearance of bilateral thalamic ischemic lesions, we must consider the Percheron´s syndrome in which the irrigation of both thalamus originates only from one of the posterior cerebral arteries (1). There are different subtypes but independently of their origins they all irrigate the bilateral thalamic paramedial regions and the rostral midbrain (2,3). Bilateral thalamic infarction usually results in an acute process of psychic and neurological deterioration of the patient. Consciousness, oculomotor and cognitive behavioural disorders are the typical presentation triad (3). In the context of our patient, the poor clinical evolution and the findings of the CT made evident a left Percheron's artery with secondary ischemic lesions that triggered the patient's death.

Written informed legal guardian patient consent for publication has been obtained
Differential Diagnosis List
Posterior cerebral artery oclussion with bilateral thalamic infartcs (Percheron´s artery)
Ischemic
Toxic-metabolic
Final Diagnosis
Posterior cerebral artery oclussion with bilateral thalamic infartcs (Percheron´s artery)
Case information
URL: https://www.eurorad.org/case/15968
DOI: 10.1594/EURORAD/CASE.15968
ISSN: 1563-4086
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