Endovascular intervention for bilateral paramedian thalamic stroke due to occlusion of the unilateral P1 segment of the posterior cerebral artery: illustrative cases.
J Neurosurg Case Lessons
; 4(2): CASE22152, 2022 Jul 11.
Article
en En
| MEDLINE
| ID: mdl-35855009
BACKGROUND: Occlusion of the unilateral P1 segment can result in bilateral paramedian thalamic infarction in patients with anatomical variants of the bilateral paramedian thalamic artery arising from a single P1 segment. Despite the life-threatening presentation of bilateral paramedian thalamic stroke, timely diagnosis is often challenging. OBSERVATIONS: The authors herein describe 3 patients treated with endovascular intervention for occlusion of the unilateral P1 segment wherein the bilateral paramedian thalamic arteries arose. All patients were admitted to the authors' emergency department with sudden-onset coma and respiratory distress; however, initial computed tomography was unremarkable. Despite suspicion of basilar artery occlusion, vertebral and carotid angiography revealed occlusion of the unilateral P1 segment. All patients were successfully treated with endovascular intervention. Overall, 2 patients had favorable outcomes (modified Rankin scale [mRS] scores of 0 and 1), whereas in 1 patient, the mRS score reached a baseline score of 3. LESSONS: In patients with the variant of the bilateral paramedian thalamic artery arising from a single P1 segment, occlusion of the unilateral P1 segment can be life threatening; nevertheless, timely endovascular treatment is effective. Carotid and vertebral angiography, rather than magnetic resonance or computed tomography angiography, is useful for immediate and reliable diagnosis of the relatively small vascular lesions.
AOP = artery of Percheron; CT = computed tomography; DTP = door-to-puncture; GCS = Glasgow Coma Scale; MR = magnetic resonance; MRI = magnetic resonance imaging; NIHSS = National Institutes of Health Stroke Scale; OTD = onset-to-door; P1 segment; PCA = posterior cerebral artery; PCoA = posterior communicating artery; PTR = puncture-to-recanalization; endovascular intervention; mRS = modified Rankin scale; paramedian thalamic stroke; posterior cerebral artery
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Colección:
01-internacional
Base de datos:
MEDLINE
Idioma:
En
Revista:
J Neurosurg Case Lessons
Año:
2022
Tipo del documento:
Article
Pais de publicación:
Estados Unidos