Bilateral thalamic infarction and DSA demonstrated AOP after thrombosis
A 61-year-old woman was admitted to the emergency room with sudden onset of unconsciousness. CT showed no acute hemorrhage or infarctions. She received thrombolysis (rt-PA) within 6 h and Glasgow Coma Scale (GCS) score was back to 15 right after. However, she still complained of drowsiness and mild memory deficit. Diffusion-weighted imaging (DWI) the next day showed symmetrical paramedian thalamic high signal intensity (Fig. ). The patient was then transferred to our hospital after 20 days. On admission she was somnolent and disoriented to time and place. Neurological examination showed vertical gaze palsy and upgoing plantar reflexes bilaterally.\nShe had no history of diabetes, hypertension, hyperlipidemia, or atrial fibrillation. Laboratory investigations were unremarkable. An MRI after three weeks showed symmetric enhanced signals in the paramedian thalamus (Fig. ). Digital subtraction angiography (DSA) showed that the P1 segment of the right PCA was absent. The P2 segment was supplied by the right posterior communicating artery (PcomA). A stenotic AOP originated from the left P1 segment was also visualized (Fig. ).\nShe was discharged 2 weeks later with full consciousness but severe cognitive impairment.