Öz
Occlusion of a variant artery ‘artery of Percheron’ causing bilateral paramedian thalamus and usually rostral midbrain infarct is infrequent in addition presentation of clinicial findings of this entity is rapid and dramatic. Therefore this scene must be recognized immediately in order to route the patient for adequate treatment. Bilateral thalamic infarcts emerge from oclussion of either arterial or venous vessels. Discrimination of underlying cause or type of occlusion not only provides appropriate treatment but also predicts prognosis of the patient. As clinical scene is wide and cumbersome for management of patient, imaging findings particularly magnetic resonans (MRI) and diffusion weighted imaging (DWI) play a key role at this point. Here in authors reported two cases of artery of Percheron infarct due to possible small vessel disease emphasising significant MRI and DWI findings in two cases and discussed clues for differential diagnosis according to literature.
Anahtar Kelimeler
Kaynakça
- Lazzaro NA, Wright B, Castillo M. Artery of Percheron infarction; imaging patterns and clinical spectrum. AJNR Am J Neuroradiol 2019;31: 1283-9
- Dela Cruz-Cosme C, Marquez-Martinez M, Agular-Cuevas R, et al. Percheron artery syndrome variability in presentation and differential diagnosis. Rev Neurol 2011; 53: 193-200
- Schmahmann JD (2003) Vascular syndromesof the thalamus. Stroke 34:2264
- Agarwal N, Tolia A, Nasberry R et al. Current differential diagnosis and teratment options of vascular occlusions presenting as bilateral infarcts: a review of the literature. J NeurolIntervent Surg 2013; 5:419-425
- Raphaeli G, Liberman A, Gomori JM, Steiner I. Acute bilateral paramedian thalamic infarcts after occlusion of the artery of Percheron. Neurology 2006;66:E7,).
- Castaigne P, Lhermitte F, Buge A, et al. Paramedian thalamic and midbrain infarct: clinical and neuropathological study. Ann Neurol 1981;10:127–48
- Carrera E Carrera E, Michel P, Bogousslavsky J. Anteromedian, central, and posterolateralinfarcts of the thalamus: three variant types. Stroke 2004;35:2826–31
- Krampla W, Schmidbauer B, Hruby W. Ischaemic stroke of the artery of Percheron. Eur Radiol 2008;18:192-194.
- Godani Godani M, Auci A, Torri T, et al. Coma with vertikal gaze palsy. : relevance of angio-CT in acute Percheron artery syndrome. Case repor Neurol 2010;2:74-9
- Kumral Kumral E, Evyapan D, Bakır K, et al. Bilateral thalamic infarction . Clinical, etiological, and MRI correlate. ACTA Neurol Scand 2001;103:35-42
- Kostanian V, Cramer SC. Artey of Percheron thrombolysis. AJNR May 2007;28:870-871
- Smith AB, Smirniotopoulos JG, Rushing EJ, Goldstein SJ Bilateral thalamic lesions. AJR Am J Roentgenol. 2009 Feb;192(2):W53-62.
Öz
Varyant bir arter olan Percheron arterin tıkanıklığı oldukça nadir görülmekte olup genellikle mezensefalon üst kesimi ile birlikte bilateral paramedian talamusta infarktla sonuçlanmaktadır. Olguların klinik bulgu ve semptomları ani ve dramatiktir. Bu nedenle tablonun hemen tanınıp hastaların uygun tedaviye yönlendirilmesi gerekmektedir. Bilateral talamik infarktlar sıklıkla arteryel ya da bazen venöz kaynaklı damar tıkanıklığı neticesinde gelişebileceğinden, altta yatan damar tıkanıklığının nedeninin ya da tipinin ortaya çıkarılması hem uygun tedavinin başlatılmasında hem de prognozun ön görülmesinde kritik öneme sahiptir. Klinik bulguların bir çok olguda yönlendirici olmaması nedeni ile görüntüleme özellikleri, özellikle manyetik rezonans görüntüleme (MRG) ve difüzyon ağırlıklı görüntüleme (DAG) bu noktada anahtar rol oynar. Bu sunumda iki olgu eşliğinde, muhtemel küçük damar hastalığı zemininde Percheron arter tıkanıklığı sonucu gelişen akut bilateral talamik infarktın klinik bulguları, konvansiyonel MRG ve DAG bulguları ve ayırıcı tanıdaki ipuçları literatür eşliğinde irdelenmiştir.
Anahtar Kelimeler
Kaynakça
- Lazzaro NA, Wright B, Castillo M. Artery of Percheron infarction; imaging patterns and clinical spectrum. AJNR Am J Neuroradiol 2019;31: 1283-9
- Dela Cruz-Cosme C, Marquez-Martinez M, Agular-Cuevas R, et al. Percheron artery syndrome variability in presentation and differential diagnosis. Rev Neurol 2011; 53: 193-200
- Schmahmann JD (2003) Vascular syndromesof the thalamus. Stroke 34:2264
- Agarwal N, Tolia A, Nasberry R et al. Current differential diagnosis and teratment options of vascular occlusions presenting as bilateral infarcts: a review of the literature. J NeurolIntervent Surg 2013; 5:419-425
- Raphaeli G, Liberman A, Gomori JM, Steiner I. Acute bilateral paramedian thalamic infarcts after occlusion of the artery of Percheron. Neurology 2006;66:E7,).
- Castaigne P, Lhermitte F, Buge A, et al. Paramedian thalamic and midbrain infarct: clinical and neuropathological study. Ann Neurol 1981;10:127–48
- Carrera E Carrera E, Michel P, Bogousslavsky J. Anteromedian, central, and posterolateralinfarcts of the thalamus: three variant types. Stroke 2004;35:2826–31
- Krampla W, Schmidbauer B, Hruby W. Ischaemic stroke of the artery of Percheron. Eur Radiol 2008;18:192-194.
- Godani Godani M, Auci A, Torri T, et al. Coma with vertikal gaze palsy. : relevance of angio-CT in acute Percheron artery syndrome. Case repor Neurol 2010;2:74-9
- Kumral Kumral E, Evyapan D, Bakır K, et al. Bilateral thalamic infarction . Clinical, etiological, and MRI correlate. ACTA Neurol Scand 2001;103:35-42
- Kostanian V, Cramer SC. Artey of Percheron thrombolysis. AJNR May 2007;28:870-871
- Smith AB, Smirniotopoulos JG, Rushing EJ, Goldstein SJ Bilateral thalamic lesions. AJR Am J Roentgenol. 2009 Feb;192(2):W53-62.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 10 Eylül 2014 |
| Yayımlandığı Sayı | Yıl 2014 Cilt: 4 Sayı: 2 EK |