ABSTRACT
O infarto da artéria de Percheron é uma apresentação rara de acidente vascular cerebral, caracterizado principalmente por isquemia talâmica bilateral. A apresentação clinica desse infarto se apresenta de maneira inesperada e variável. Relata-se um caso de um paciente masculino, idoso, acometido por diversas comorbidades, admitido na emergência em coma e hemiplégico a direita, demonstrando acometimento neurológico. A condição clínica do paciente variou durante a hospitalização, apresentando melhora do quadro neurológico focal e midríase fixa à direita, levando a um diagnóstico tardio. Paciente evoluiu ao óbito devido a causas não neurológicas.
The artery of Percheron infarct is a rare presentation of stroke, featured mainly by thalamic bilateral ischemia. The clinical presentation of this infarct is unexpected and variable. It's reported a case of a male patient, elderly, affected with several comorbidities, admitted to the emergency in comatose state and right hemiplegic, proving neurological involvement. The patient's clinical condition has fluctuated throughout the hospitalization presenting improvement of the focal neurologic implication and right mydriasis, culminating in a lagged diagnosis. Patient's death due to non neurologic causes.
Subject(s)
Humans , Male , Aged , Cerebral Infarction/diagnostic imaging , Thalamus/blood supply , Thalamus/diagnostic imaging , Tomography, X-Ray Computed , Comorbidity , Risk Factors , Fatal OutcomeABSTRACT
El infarto talámicoparamediano bilateral sincrónico,llamado habitualmente infarto de la arteria de Percheron, se considera infrecuente y de difícil diagnóstico clínico. Se presenta a una paciente de 50 años, con infarto talámico bilateral, que presentó un cuadro de desorientación, visión borrosa y doble en horas de la mañana, sin referir pérdida de conciencia. En la tomografía axial computarizada de cráneo simple se evidenció una hipodensidad talámica bilateral, compatible con un infarto agudo a este nivel, por oclusión de la arteria de Percheron. Es importante el reconocimiento de esta variante anatómica para establecer el mecanismo del infarto talámico bilateral.
Subject(s)
Cerebral Infarction , Stroke, Lacunar , Thalamus/blood supplyABSTRACT
Antecedentes: La presencia de foramen oval permeable se asocia a infartos cerebrales criptogénicos en pacientes jóvenes. Caso clínico: Hombre de 27 años en quien se inició de forma súbita síndrome confusional agudo, bradipsiquia y somnolencia. La imagen de resonancia magnética cerebral mostró infarto talámico bilateral simétrico por probable oclusión de arteria de Percheron tipo 2b. El ecocardiograma identificó foramen oval permeable. Conclusiones: El evento cerebrovascular es causa frecuente de discapacidad e incluso muerte en población joven. Debe hacerse énfasis en el estudio integral de esta patología.
BACKGROUND: Patent foramen ovale (PFO) has been associated with cryptogenic stroke in young patients. CLINICAL CASE: A 27-year-old man presented with acute confusional syndrome, altered language, bradypsychia and somnolence. Brain MRI showed symmetrical bilateral thalamic infarctions probably due to occlusion of Percheron's artery type 2b. Echocardiography showed patent foramen ovale. CONCLUSIONS: Cerebrovascular disease is a frequent cause of disability and even death in young patients, and thus its medical approach should be emphasized.
Subject(s)
Humans , Male , Adult , Foramen Ovale, Patent/complications , Brain Infarction/etiology , Thalamus/blood supply , Acute DiseaseSubject(s)
Female , Humans , Middle Aged , Cerebral Infarction/complications , Dementia, Vascular/etiology , Thalamic Diseases/etiology , Thalamus/blood supply , Amnesia/physiopathology , Cerebral Infarction/physiopathology , Magnetic Resonance Imaging , Memory/physiology , Tomography, Emission-Computed, Single-Photon , Thalamus/physiopathologyABSTRACT
We report neurofunctional changes in patients with selfmutilation and bipolar disorder. We compared a sample of 29 patients with selfmutilation and bipolar disorder with a group of 20 patients with bipolar disorder without selfmutilation. Furthermore we had an additional control of 22 patients with Major Depression without selfmutilation. Among the findings in selfmutilation, increased anterior dorsal-ventral thalamic perfusion stands out, this is associated with decreased perfusion in the perilimbic area (areas 24, 32 and 23 of Brodmann). There are multiple reports relating in animals and humans selfmutilation with hypoalgesia, anesthesia and disestesias; an hypothesis can be formulated relating self mutilation phenomena with a dysfunction of thalamus and perilimbic circuits associated with nosoceptive circuits and somato-psychic conscience.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Tomography, Emission-Computed, Single-Photon , Self Mutilation/complications , Bipolar Disorder , Bipolar Disorder/complications , Bipolar Disorder/physiopathology , Cerebral Cortex , Cerebral Cortex/blood supply , Depersonalization , Thalamus , Thalamus/blood supplyABSTRACT
Hiperssexualidade é uma condição rara mas bem reconhecida após lesão do sistema nervoso central. A literatura medica registra casos secundários a disfunção do hipotálamo, do lobo temporal e do lobo frontal. Relatamos o caso de um homem de 63 anos de idade que desenvolveu alterações neuropsicológicas com hiperssexualidade como característica mais proeminente, desinibição, moderada perda de memória, hipersonia e irritabilidade após infarto talâmico paramediano bilateral. O SPECT evidenciou hipoperfusão frontal. Nós acreditamos que esses achados sejam expressão da disfunção de circuitos córtico-subcorticais frontais, particularmente do circuito órbito-frontal, secundária ao infarto dorsomedial do tálamo, que provavelmente desempenha papel relevante na determinação do comportamento sexual humano. Este caso favorece uma possível função moduladora do tálamo sobre os circuitos córtico-subcorticais frontais.
Subject(s)
Humans , Male , Middle Aged , Cerebral Infarction/complications , Sexual Dysfunction, Physiological/etiology , Thalamic Diseases/complications , Thalamus/blood supply , Cerebral Infarction/diagnosis , Frontal Lobe , Tomography, Emission-Computed, Single-Photon , Thalamic Diseases/diagnosisABSTRACT
A 58-year-old woman presented with an acute embolic occlusion of the distal basilar artery. She underwent angioplasty and intra-arterial thrombolysis. Angiography performed after recanalization revealed a single perforating thalamic artery. A nonenhanced CT scan carried out immediately after the procedure revealed hyperdense lesions in the bilateral paramedian portions of the thalami, which disappeared on the 24-hour follow-up CT scan. Three months later, the patient improved to functional independence, but had some memory dysfunction and vertical gaze palsy. This case suggests that contrast enhancement or extravasation can occur in the thalamus after intra-arterial thrombolysis performed to recanalize a basilar artery occlusion.
Subject(s)
Female , Humans , Middle Aged , Angioplasty , Basilar Artery/diagnostic imaging , Contrast Media , Intracranial Embolism and Thrombosis/diagnostic imaging , Thalamus/blood supply , Thrombolytic Therapy , Tomography, X-Ray ComputedABSTRACT
Se presentan tres casos de infartos talámicos bilaterales y simultáneos, haciéndose una revisión histórica de la patología isquémica talámica a partir de la descripción inicial del síndrome talámico de Dejerine y Roussy. Se describe la vascularización talámica y la clínica del infarto talámico, correlacionándola con los hallazgos tomográficos y discutiéndose los mecanismos etiopatogénicos
Subject(s)
Humans , Male , Female , Middle Aged , Cerebral Infarction/complications , Thalamus/blood supply , Thalamus/pathology , Cerebral Infarction/diagnosisABSTRACT
O presente trabalho relata o caso de um diabético hipertenso acometido de uma forma fragmentária da síndrome de Dejerine-Roussy e "sensaçao de câimbra dolorosa" nos artelhos quando se deitava ou removia o pé do contato com o chao. A propriocepçao estava acentuadamente comprometida nos artelhos que abrigavam a câimbra. Seu relato se adequava ao padrao das distonias fixas, nao transcrita, todavia, como deformidade motora visível razao pela qual designamos o fenômeno de "distonia virtual". A RNM mopstrou imagem infarto do núcleo lateral posterior do tálamo (VPL) e degeneraçao walleriana de projeçoes VLP-corticais. O SPECT, exclusao do tálamo e hipoperfusao do córtex parietal dorsal ipsilateral e dos núcleos da base bilateralmente. Sugerimos que, em decorrência da interrupçao de aferentes proprioceptivos no tálamo, o córtex somestésico (S-I) originou atividade topograficamente ordenada que emergiu sob a forma de distonia como representaçao mental subjetiva. Sugerimos que a distonia virtual represente o análogo somestésico das alucinoses unimodais, cujo exemplo mais conhecido é a síndrome de Bonnet.
Subject(s)
Humans , Male , Adult , Cerebral Infarction/complications , Dystonia/diagnosis , Dystonia/etiology , Proprioception , Thalamus/blood supply , Magnetic Resonance Spectroscopy , Syndrome , Tomography, Emission-Computed, Single-PhotonABSTRACT
Relata-se o caso de uma jovem, heterozigota para doença de Fabry, que desenvolveu infartos talâmicos bilaterais por oclusäo de vasos do sistema nervoso central. Três outros membros de sua família foram também avaliados. A doença de Fabry inclui-se entre as causas raras de acidente vascular cerebral em adultos jovens
Subject(s)
Humans , Male , Female , Adult , Aged , Middle Aged , Cerebral Infarction/etiology , Fabry Disease/genetics , Thalamus/blood supply , Fabry Disease/complicationsABSTRACT
The traditional concept of a clear demarcation between the vascular supply of the internal capsule and the thalamus cannot be regarded as absolute. Two cases of sensorimotor stroke due to posterior cerebral artery territory infarction are described, with CT evidence of internal capsular involvement.
Subject(s)
Aged , Brain/blood supply , Cerebral Infarction/diagnosis , Cerebrovascular Disorders/diagnosis , Hemiplegia/diagnosis , Humans , Male , Thalamus/blood supplyABSTRACT
We report three patients who lapsed into coma and subsequently manifested hypersomnolence, amnesia and vertical gaze paresis. Computed tomography revealed bilateral paramedian thalamic infarcts. This clinical symptomatology comprises the paramedian diencephalic syndrome.
Subject(s)
Aged , Cerebral Infarction/complications , Coma/etiology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Syndrome , Thalamus/blood supplyABSTRACT
We report a 25 year old male who suffered thalamic and multiple cerebellar infarctions during infrequent attacks of basilar artery migraine. Migraine-related infarcts at these sites are uncommon.