title: Artery of Percheron infarction as an unusual cause of coma: three cases and literature review.
abstract: OBJECTIVE
  Stroke due to occlusion of the artery of Percheron (AOP), an uncommon anatomic variant supplying the bilateral medial thalami, may raise diagnostic challenges and cause life-threatening symptoms. Our objective here was to detail the features and outcomes in three patients who required intensive care unit (ICU) admission and to review the relevant literature.
  
  
  METHODS
  Description of three cases and literature review based on a 1973-2013 PubMed search.
  
  
  RESULTS
  Three patients were admitted to our ICU with sudden-onset coma and respiratory and cardiovascular dysfunctions requiring endotracheal mechanical ventilation. Focal neurological deficits, ophthalmological signs (abnormal light reflexes and/or ocular motility and/or ptosis), and neuropsychological abnormalities were variably combined. Initial CT scan was normal. Cerebral MRI demonstrated bilateral paramedian thalamic infarction, with extension to the cerebral peduncles in two patients. Consciousness improved rapidly and time to extubation was 1-4 days. All three patients were discharged alive from the hospital and two had good 1-year functional outcomes. Similar clinical features and outcomes were recorded in the 117 patients identified in the literature, of whom ten required ICU admission.
  
  
  CONCLUSIONS
  Bilateral paramedian thalamic stroke due to AOP occlusion can be life threatening. The early diagnosis relies on MRI with magnetic resonance angiography. Recovery of consciousness is usually rapid and mortality is low, warranting full-code ICU management.
authors.affiliation: Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, 78150, Le Chesnay, France, nzap@live.fr.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Zappella
authors.forename: Sybille
authors.initials: S
authors.lastname: Merceron
authors.forename: Chantal
authors.initials: C
authors.lastname: Nifle
authors.forename: Julia
authors.initials: J
authors.lastname: Hilly-Ginoux
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.forename: Gilles
authors.initials: G
authors.lastname: Troché
authors.forename: Yves-Sebastien
authors.initials: YS
authors.lastname: Cordoliani
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bedos
authors.forename: Fernando
authors.initials: F
authors.lastname: Pico
authors.forename: Stephane
authors.initials: S
authors.lastname: Legriel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000473:pathology; D002544:Cerebral Infarction / Q000209:etiology* / Q000473:pathology; D002941:Circle of Willis / Q000473:pathology; D003128:Coma / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D020645:Mediodorsal Thalamic Nucleus / Q000098:blood supply / Q000473:pathology*; D020769:Posterior Cerebral Artery / Q000473:pathology*