Öz
Percheron arteri (PA), talamik bölgeyi besleyen talamoperforan arterlerin nadir bir anatomik varyantıdır. PA tıkanıklığı klinik pratikte “bukalemun inme” olarak tanımlanır çünkü klasik inme semptomlarını içermez. PA enfarktı bilateral talamik bölge iskemisi ile karakterize nadir bir durumdur.Genel popülasyonda anatomik bir varyant olarak PA görülme sıklığı %4-%11 arasında iken, bu arterin tıkanıklığı ile ortaya çıkan klinik durumun görülme sıklığı %0.1-%2 arasındadır. Vaka sunumunda elli altı yaşında erkek hasta, yakınları tarafından birkaç gündür olan uykusuzluk, unutkanlık ve sinirlilik hali nedeniyle psikiyatri polikliniğine götürülmüş. Psikiyatri hekimi tarafından yapılan muayenesinde semptomların psikiyatrik nedenlerden ziyade organik nedenlere bağlı olabileceği düşünülerek hasta acil servise yönlendirilmiş.Hastanın şikayetine yönelik bulguların santral sistem patolojisine ait olabileceği düşünülerek hastaya difüzyon MR çekildi ve Difüzyon MR’da bilateral talamik alanlarda akut iskemiile uyumlu görünümler izlendi.Percheron arter enfarktında klinik prezentasyon koma gibi hayatı tehdit edecek kadar ciddi ve belirgin şekilde olabildiği gibi, vaka örneğindeki gibi sadece silik davranış bozuklukları ile de olabilir ve hastalar acil servise ya da nöroloji polikliniğine başvurmak yerine psikiyatri polikliniğine başvurabilir. Uyku düzensizliği, hafıza problemleri, davranışsal değişiklikler gibi non-spesifik şikayetler ile acil servise veya polikliniklere başvuran hastalarda nadir bir klinik durum olanpercheron arter enfarktı ayırıcı tanılar arasında düşünülmelidir.
Anahtar Kelimeler
Kaynakça
- 1. YANG, Fu-Yi, HUNG, Jeng-Luen ve LIN, Shinn-Kuang. Percheron Artery-Plus Syndrome: A Syndrome Beyond Stroke Chameleon. Journal of Nippon Medical School, 2021, 88.4: 375-379.
- 2. RAMALHO, Carina, et al. Artery of Percheron Occlusion: A Diagnostic Challenge. European Journal of Case Reports in Internal Medicine, 2021, 8.11.
- 3. KOCAELI, Hasan, et al. The artery of Percheron revisited: A cadaveric anatomical study. 2013.
- 4. AGARWAL, Nitin, et al. Redefining thalamic vascularization vicariously through Gerald Percheron: a historical vignette. World Neurosurgery, 2014, 81.1: 198-201.
- 5. GODANI, M., et al. Coma with vertical gaze palsy: Relevance of angio-CT in acute percheron artery syndrome. Case Reports in Neurology, 2010, 2.2: 74-79.
- 6. CASSOURRET, Guillaume, et al. Ischemic stroke of the artery of Percheron with normal initial MRI: a case report. Case reports in medicine, 2010, 2010.
- 7. COSSON, A., et al. Arterial vascularization of the human thalamus: extra-parenchymal arterial groups. Surgical and Radiologic Anatomy, 2003, 25.5: 408-415.
- 8. KICHLOO, Asim, et al. Artery of Percheron infarction: a short review. Journal of Investigative Medicine High Impact Case Reports, 2019, 7: 2324709619867355.
- 9. YAKUPOĞLU, Ezgi, et al. Percheron arter enfarktı: olgu sunumu. Türk Beyin Damar Hastalıkları Dergisi, 2018, 24.3: 119-123.
- 10. RISSARDO, Jamir Pitton ve CAPRARA, Ana Fornari. Isolated acute pseudobulbar palsy with infarction of artery of percheron: case report and literature review. African Health Sciences, 2021, 21.1: 166-71.
- 11. LAZZARO, Nicholas A., et al. Artery of percheron infarction: imaging patterns and clinical spectrum. American journal of neuroradiology, 2010, 31.7: 1283-1289.
- 12. SCHMAHMANN, Jeremy D. Vascular syndromes of the thalamus. Stroke, 2003, 34.9: 2264-2278.
- 13. ARAUZ, Antonio, et al. Clinical spectrum of artery of percheron infarct: Clinical–radiological correlations. Journal of Stroke and Cerebrovascular Diseases, 2014, 23.5: 1083-1088.
- TILKI, Hacer Erdem, DIDEM, E. R. ve İNCESU, Lütfi. Acute Aphasia Due to Percheron Artery Occlusion. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi, 2011, 2.1: 39-44.
Öz
The artery of Percheron (PA) is a rare anatomical variant of the thalamoperforating arteries supplying the thalamic region. PA obstruction is defined in clinical practice as a “chameleon stroke” because it does not include the classic stroke symptoms. PA infarction is a rare condition characterized by bilateral thalamic region ischemia. While the incidence of PA as an anatomical variant in the general population is between 4% and 11%, the incidence of clinical condition resulting from occlusion of this artery is between 0.1% and 2%. In the case report, a fifty-six-year-old male patient was taken to the psychiatry polyclinic by his relatives due to insomnia, forgetfulness and nervousness for a few days. In the examination performed by a psychiatrist, the patient was referred to the emergency department, considering that the symptoms might be due to organic rather than psychiatric reasons. The clinical presentation can be life-threatening and severe, such as coma, or only with subtle behavioral disorders, as in the case example, and patients may apply to the psychiatry outpatient clinic instead of applying to the emergency department or neurology outpatient clinic. Percheron artery infarction, which is a rare clinical condition, should be considered among the differential diagnoses in patients who present to the emergency department or outpatient clinics with non-specific complaints such as sleep disturbance, memory problems, and behavioral changes.
Anahtar Kelimeler
Kaynakça
- 1. YANG, Fu-Yi, HUNG, Jeng-Luen ve LIN, Shinn-Kuang. Percheron Artery-Plus Syndrome: A Syndrome Beyond Stroke Chameleon. Journal of Nippon Medical School, 2021, 88.4: 375-379.
- 2. RAMALHO, Carina, et al. Artery of Percheron Occlusion: A Diagnostic Challenge. European Journal of Case Reports in Internal Medicine, 2021, 8.11.
- 3. KOCAELI, Hasan, et al. The artery of Percheron revisited: A cadaveric anatomical study. 2013.
- 4. AGARWAL, Nitin, et al. Redefining thalamic vascularization vicariously through Gerald Percheron: a historical vignette. World Neurosurgery, 2014, 81.1: 198-201.
- 5. GODANI, M., et al. Coma with vertical gaze palsy: Relevance of angio-CT in acute percheron artery syndrome. Case Reports in Neurology, 2010, 2.2: 74-79.
- 6. CASSOURRET, Guillaume, et al. Ischemic stroke of the artery of Percheron with normal initial MRI: a case report. Case reports in medicine, 2010, 2010.
- 7. COSSON, A., et al. Arterial vascularization of the human thalamus: extra-parenchymal arterial groups. Surgical and Radiologic Anatomy, 2003, 25.5: 408-415.
- 8. KICHLOO, Asim, et al. Artery of Percheron infarction: a short review. Journal of Investigative Medicine High Impact Case Reports, 2019, 7: 2324709619867355.
- 9. YAKUPOĞLU, Ezgi, et al. Percheron arter enfarktı: olgu sunumu. Türk Beyin Damar Hastalıkları Dergisi, 2018, 24.3: 119-123.
- 10. RISSARDO, Jamir Pitton ve CAPRARA, Ana Fornari. Isolated acute pseudobulbar palsy with infarction of artery of percheron: case report and literature review. African Health Sciences, 2021, 21.1: 166-71.
- 11. LAZZARO, Nicholas A., et al. Artery of percheron infarction: imaging patterns and clinical spectrum. American journal of neuroradiology, 2010, 31.7: 1283-1289.
- 12. SCHMAHMANN, Jeremy D. Vascular syndromes of the thalamus. Stroke, 2003, 34.9: 2264-2278.
- 13. ARAUZ, Antonio, et al. Clinical spectrum of artery of percheron infarct: Clinical–radiological correlations. Journal of Stroke and Cerebrovascular Diseases, 2014, 23.5: 1083-1088.
- TILKI, Hacer Erdem, DIDEM, E. R. ve İNCESU, Lütfi. Acute Aphasia Due to Percheron Artery Occlusion. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi, 2011, 2.1: 39-44.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Acil Tıp, Radyoloji ve Organ Görüntüleme |
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Yayımlanma Tarihi | 6 Eylül 2023 |
| Gönderilme Tarihi | 25 Ocak 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 37 Sayı: 2 |
