Medicine news

Clinical Pearl: How to Recognize a Bilateral Thalamic Stroke : Emergency Medicine News

Figure:

Percheron’s artery, stroke

BY EMEDHOME.COM

Percheron’s artery is a variant of the arterial supply to the thalamus in which a single artery supplies both sides of the thalamus and the midbrain. Occlusion of this artery can lead to a bilateral thalamic stroke.

Knowledge of the PDO and its occlusion is crucial for patient care and recovery. Patients exhibit unique characteristics such as excessive sleepiness and confusion during an infarction. (priest. 2021;13[11]:e19783; https://bit.ly/37L6jof.)

PDO infarcts have four main acute characteristics: paralysis of vertical gaze (65%), memory impairment (58%), confusion (53%) and coma (42%). Three major difficulties are observed with this type of stroke:

  • Excessive drowsiness, leading to problems requiring a story. The coma-like presentation may delay diagnosis and limit post-stroke treatment.
  • The initial cranial CT scan shows no acute findings in most cases. This can mislead doctors to seek an alternative diagnosis for an altered mental state. Early therapeutic intervention is not considered accordingly.
  • Lack of familiarity with a PDO infarction and its clinical characteristics.

These barriers can have a significant negative impact on a patient’s prognosis. A Percheron infarction artery should also be retained in the differential diagnosis when elderly patients present with an altered mental state.

Consider follow-up imaging (MRI) when significant alteration in consciousness does not match initial imaging findings, especially when other subtle clinical signs are present (eg, paralysis of vertical gaze). (Neurol behavior. 2014;2014:154631; https://bit.ly/3vqNlMG; Neurohospitalist. 2018;8[3]:141; https://bit.ly/3vQdPWL.)

This clinical pearl first appeared onwww.EMedHome.com, which emails subscribers a new clinical pearl every Wednesday.

EMedHome.com on EM-News.com

Visit our website to watch videos from emergency medicine experts (http://bit.ly/EMN-EMedHomeVideos) and podcasts from Amal Mattu, MD, and other top emergency physicians from EMedHome.com (http://bit.ly/MattuEMN).

Video of the month

Mimi Lu, MD: What’s New in Pediatric Emergency Medicine: http://bit.ly/EMN-EMedHomeVideos. Dr. Lu is an associate clinical professor of emergency medicine at the University of California, San Francisco.

Podcast of the month

Amal Mattu, MD, and colleagues: ACE inhibitor angioedema, sepsis: beyond bundle and neonatal fever: http://bit.ly/MattuEMN. Dr. Mattu is a top lecturer in emergency medicine, professor of emergency medicine, and vice chair of emergency medicine at the University of Maryland School of Medicine in Baltimore.