title: Fluctuating drowsiness following cardiac catheterisation: artery of Percheron ischaemic stroke causing bilateral thalamic infarcts.
abstract: An 81-year-old man underwent cardiac catheterisation to investigate breathlessness and left ventricular impairment of unknown cause. He had unobstructed coronary arteries. Immediately following the procedure, he became suddenly unresponsive with vertical gaze palsy, anisocoria and bilateral upgoing plantar responses. He made a rapid recovery to his premorbid state 25 min later with no residual focal neurological signs. He then had multiple unresponsive episodes, interspaced with complete resolution of symptoms and neurological signs. MRI of the brain identified bilateral medial thalamic infarcts and midbrain infarcts, consistent with an artery of Percheron territory infarction. By the time the diagnosis was reached, the thrombolysis window had elapsed. The unresponsive episodes diminished with time and the patient was discharged to inpatient rehabilitation. At 6-month review after the episode, the patient has a degree of progressive cognitive impairment.
authors.affiliation: Cardiology Department, Western Sussex Hospitals NHS Trust, Worthing, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hammersley
authors.affiliation: Radiology Department, Western Sussex Hospitals NHS Trust, Worthing, UK.
authors.forename: Ankur
authors.initials: A
authors.lastname: Arora
authors.affiliation: Cardiology Department, Western Sussex Hospitals NHS Trust, Worthing, UK.
authors.forename: Madhava
authors.initials: M
authors.lastname: Dissanayake
authors.affiliation: Department of Stroke and Elderly Care, Western Sussex Hospitals NHS Trust, Worthing, West Sussex, UK.
authors.forename: Nabarun
authors.initials: N
authors.lastname: Sengupta
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002544:Cerebral Infarction / Q000209:etiology*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008636:Mesencephalon / Q000098:blood supply; D012894:Sleep Stages; D020521:Stroke / Q000209:etiology*; D013788:Thalamus / Q000098:blood supply*