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FAT EMBOLISM SYNDROME: CHALLENGING ACUTE STROKE

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Presented at

11th World Stroke Congress

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Abstract

INTRODUCTION: The Percheron Artery is a rare variant of the posterior cerebral circulation, usually identified in a case of bilateral thalamic stroke. Clinical features of an infarction of this artery includes altered mental status or hypersomnolence, vertical gaze palsy and memory impairment. Hardly seen in angiotomography or even in angiography, this variant consists in a unique arterial branch of the posterior cerebral artery, which divides into two other branches that supplies blood to the paramedian thalami and bilateral rostral midbrain. METHODS: Case Report. RESULTS: An 85- year-old caucasian female presented herself in the Emergency room with torpor, unable to be awoken, in deep drowsiness hardly responsive to pain stimulus. Her vital signs were not affected. The patient’s past medical history included diagnosis of mixed dementia, arterial hypertension, diabetes type 2 and three prior ischemic strokes. Excluded iatrogenic and infection causes, she underwent brain MRI which showed in diffusion-weighed imaging a recent bilateral thalamic ischemic lesion, confirmed by apparent diffusion coefficient. Final diagnosis was of infarct of artery of Percheron, classified as Small Vessel occlusion on TOAST classification (penetrating branches of the posterior cerebral artery). As she already used aspirin continuously, it was added Clopidogrel and Rosuvastatin to her therapy, as no critical estenosis were diagnosed on the cervical and cranial angioCT. On the follow up, patient presented apathy and progressive dependency for daily-life acitivities, consistent with those signs usually seen after thalamic lesions. CONCLUSION: In cases of sudden mental status alteration of hypersomnolence, bilateral thalamic stroke should be investigated.

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All rights reserved.