CLINICAL СASE: 41-YEAR MAN WITH NEUROLOGICAL SIGNS AND BACK PAIN AFTER PHYSICAL EXERCISES AND UNUSUAL IMAGING APPEARANCES.

The aim was to describe the uncommon cause of back pain with successful treatment, precise diagnostic and good outcome. Lower back pain is prevalent among all the age groups and can derive from many potential anatomic sources. Here is presented the case of atypical course of back pain and neurological signs with point on importance of astute visualizations technics. This clinical case of 41-year old male patient who got back pain and neurological signs after intensive physical exercises and had no adequate response for anti-inflammatory and analgesic drugs demonstrated the importance of appropriate visualization and considering non-standard causes of these symptoms. This allowed to prescribe effective treatment with good outcome during follow-up period. This could be the supporting evidence for including such additional visualization in protocols for non-typical back pain after strenuous physical activity. Back pain is common condition with a variety of causes. It is important to consider them in case of inadequate results of treatment and use non-conventional investigation if appropriate, which improves the outcome. This could be the supporting evidence for including such additional visualization in protocols for non-typical back pain after strenuous physical activity.

Stroke in the artery of percheron territory: the two edges of one diagnosis.

Occlusion of artery of Percheron is a rare condition caused by a peculiar anatomic variation in cerebral blood supply, leading to a bilateral thalamic infarction. Strokes in artery of Percheron account for 0.1% to 2% of all cerebral infarctions. Thalamic area is supplied by the arteries arising directly from the P1 segment of the posterior cerebral artery. However, in 1/3 of cases the supply is provided by a single trunk referred to as artery of Percheron (AOP). Early diagnosis of stroke in AOP can be very challenging due to an ambiguous clinical presentation and the absence of neurovisualization findings. This article presents two clinical cases of stroke in artery of Percheron observed at Lviv Emergency Hospital. Different clinical progression of a cerebrovascular accident contrasted with a similar neurovisualization pattern was a distinctive feature in these patients. Taking into consideration the rarity of this condition and a characteristic clinical presentation, these clinical cases were retrospectively analyzed and compared. A stroke in AOP should be suspected in all patients with symptoms of interrupted blood supply in the vertebrobasilar territory. The diagnosis primarily depends on clinical features; patients with paramedian bilateral thalamic lesions may develop sudden problems with consciousness, vertical gaze palsy and memory disorders. Early diagnosis of this condition allows for more effective therapeutic interventions and improves patient prognosis.