266 A drowsy patient: beyond the familiar territory

A 72-year-old man was brought to the hospital after he was found unresponsive at home by his wife who reported that he has been sleepy in the last few days.
He has a background of hypertension, myocardial infarct, and osteoarthritis. His medications include anti-hypertensive and morphine sulphate.
On examination, he was drowsy with GCS fluctuating between 9–11 but maintaining his airways. He was moving all four limbs; pupils were small and unequal but reactive to light. Planter reflexes were downgoing.
Opioid toxicity was suspected and treated with naloxone without any response.
The CT head scan showed no acute pathology. He was subsequently started on IV ceftriaxone and acyclovir for possible meningitis and encephalitis.
He later had an MRI, which showed restricted diffusion in bilateral paramedian thalami.
Artery of Percheron is a rare anatomic variant where a single branch of posterior cerebral artery supplies blood to paramedian thalami and part of rostral midbrain bilaterally. AOP stroke accounts only 0.1% to 2% of all ischemic strokes. The presentation is variable due to the numerous functions relayed through the thalamus. MRI is diagnostic.
Due to the non-classic stroke signs/symptoms and the lack of clinical awareness, timely diagnosis of AOP infarct is quite challenging.
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Source: Journal of Neurology, Neurosurgery and Psychiatry - May 27, 2022 Category: Neurosurgery Authors: Oo, A., Khine, N. Tags: Poster Presentations Source Type: research