Abstract
An 88-year-old woman with a medical history of diabetes, hypertension, and atrial fibrillation presented to the emergency room after being found unresponsive with a NIH Stroke Scale score of 23 and Glasgow Coma Scale score of 3. She was unresponsive to painful stimuli. Noncontrast CT demonstrated bilateral thalamic infarcts (figure 1A).
An 88-year-old woman with a medical history of diabetes, hypertension, and atrial fibrillation presented to the emergency room after being found unresponsive with a NIH Stroke Scale score of 23 and Glasgow Coma Scale score of 3. She was unresponsive to painful stimuli. Noncontrast CT demonstrated bilateral thalamic infarcts (figure 1A).
Figure 1. CT and magnetic resonance angiography.
(A) Noncontrast CT scan of the head shows bilateral thalamic infarcts (arrowheads) and right posterior cerebral artery distribution infarct. (B) Magnetic resonance angiography time-of-flight shows an occluded right internal carotid artery.
Bilateral thalamic infarcts are an unusual presentation of stroke. Our patient had a right internal carotid artery (RICA) occlusion in the setting of fetal origin posterior cerebral artery supplying the artery of Percheron (single arterial trunk [figure 2] feeding both paramedian thalami1,2). This anatomical variant led to bilateral thalamic infarcts secondary to an RICA occlusion (figure 1B).
Figure 2. Axial (A) and coronal (B) maximum intensity projections.
CT angiography from 2008 demonstrates a fetal origin posterior cerebral artery (arrowhead) and artery of Percheron supplying both thalami (arrow).
AUTHOR CONTRIBUTIONS
Dr. Haitham Dababneh drafted and edited the manuscript. Drs. Guerrero, Shikhman, Moussavi, and Panezai edited the article. Dr. Kirmani edited and revised the article.
STUDY FUNDING
No targeted funding reported.
DISCLOSURE
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
REFERENCES
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