Clinical Study On Bilateral Thalamic Infarction Due To Occlusion Of The Artery Of Percheron

Objective: Bilateral thalamic infarction due to occlusion of the artery of Percheron(AOP infarction)is rare in clinical work,and its clinical features are complex and changeable.Serious cases can be life threatening.This study collected the clinical and imaging data of domestic AOP infarction cases in the past ten years,described and summarized the common clinical manifestations,etiology,imaging features,management strategies and prognosis of the disease,in order to improve clinical understanding of the disease.Methods: Retrospective analysis and follow-up of the case data of 2 patients with AOP infarction admitted to the branch of East Hospital of the Second Hospital of Hebei Medical University from October 2018 to December 2019.The CNKI and Wanfang database were used to search and sort the data of cases diagnosed with AOP infarction in China from 2010 to 2019.They were combined and summarized as a series of AOP infarction cases,and the descriptive analysis.Results: A total of 60 cases of AOP infarction were collected,including 2 admitted and 58 searched.50 cases developed onset with varying degrees of conscious disturbance,accounting for 83.3%,of which 19 were somnolence(31.7%),7 were stupor(11.7%),and 24 were coma(40%),34 cases(56.7%)showed ocular movement abnormalities,20 patients(33.3%)recorded cognitive impairment;38 cases(63.3%)were considered to be caused by embolism,of which 18 cases(30%)were considered to be cardioembolism,2 cases could not be ruled out as possible of cardioembolism,16 cases(26.7%)were considered to be artery-to-artery embolism or carrier artery atherosclerotic plaque embolism,2 cases were paradoxical embolism,21 cases(35%)were considered as small artery-disease,1 case was unknown,and the cause of non-arterial embolism in patients younger than 45 years of age reached 50%;53 patients received conventional medical treatment,6 patients received intravenous thrombolysis therapy within a time window,and 1 patient received stent placement;the prognosis of follow-up was recorded in 55 cases,including 48 patients with conventional medical treatment and 7 patients with revascularization,of which 11 cases(22.9%,11/48)underwent conventional drug therapy and 4 cases(57.1%,4/7)after recanalization had good outcome,and no obvious sequelae remained;the remaining patients had varying degrees of symptoms left over;20 patients reported memory loss,17 patients had varying degrees of eye movement disorders,and 9 patients had left speech dysfunction.3 cases left minor limb movement disorders but did not affect daily life.Conclusions: AOP infarction is mainly manifested in varying degrees of conscious disturbance,eye movement disorder and cognitive impairment;the cause may be related to the embolism mechanism caused by various factors,and the cardioembolism is the most common,followed by small artery-disease;because it is not easy to diagnose or the diagnosis is delayed,clinical treatments are mostly conventional stroke medications;AOP infarction often has a favorable outcome,early endovascular revascularization therapy can significantly improve the prognosis of patients with AOP infarction,but most patients rarely recover completely,leaving long-term memory,eye movement,speech dysfunction and dyskinesia.