Abstract：
OBJECTIVE: Bilateral thalamic infarction due to artery of Percheron (AOP) occlusion is rare (0.01-2% of all ischemic strokes) and neuropsychological sequelae are not well-defined. We present the case of a 50-year-old, right-handed, Caucasian woman, with 12 years of education, who presented with cognitive and behavioral symptoms following AOP stroke.
METHODS: Following AOP stroke, the patient experienced seven-day hospitalization and one-month subacute rehabilitation. Symptoms after discharge from the latter included vertical gaze palsy, mild balance difficulties, impulsivity, and amnesia (retrograde and anterograde). Compared to neuroimaging five days after stroke, follow up imaging at three months revealed bilateral thalamic encephalomalacia (Figure 1), as well as small bilateral cerebellar infarcts. Neuropsychology was consulted six months post-stroke to evaluate persistent cognitive and emotional/behavioral symptoms.
RESULTS: (Test results in Table 1). Test results demonstrated average estimated premorbid functioning, amnesia (anterograde and retrograde) and executive dysfunction (including emotional lability, stimulus bound behaviors), which interfered with performances on processing speed and verbal fluency tasks. Attention, working memory, and core language/visuospatial skills were spared. These symptoms contributed to difficulty navigating/exacerbation of psychosocial stress and necessitated external support for daily functions. Neuropsychological evaluation data were used to identify strategies to optimize patient coping and reduce caregiver burnout. At 16-months post-stroke, persistent amnesia and reduced emotional lability were reported by her family.
CONCLUSIONS: This case highlights the presence and need to characterize cognitive and behavioral deficits following bilateral thalamic infarction. Additionally, this case demonstrates the role of neuropsychology in characterization of cognitive and neuropsychiatric sequelae, including identification of relevant interventions/recommendations to inform treatment planning.
METHODS: Following AOP stroke, the patient experienced seven-day hospitalization and one-month subacute rehabilitation. Symptoms after discharge from the latter included vertical gaze palsy, mild balance difficulties, impulsivity, and amnesia (retrograde and anterograde). Compared to neuroimaging five days after stroke, follow up imaging at three months revealed bilateral thalamic encephalomalacia (Figure 1), as well as small bilateral cerebellar infarcts. Neuropsychology was consulted six months post-stroke to evaluate persistent cognitive and emotional/behavioral symptoms.
RESULTS: (Test results in Table 1). Test results demonstrated average estimated premorbid functioning, amnesia (anterograde and retrograde) and executive dysfunction (including emotional lability, stimulus bound behaviors), which interfered with performances on processing speed and verbal fluency tasks. Attention, working memory, and core language/visuospatial skills were spared. These symptoms contributed to difficulty navigating/exacerbation of psychosocial stress and necessitated external support for daily functions. Neuropsychological evaluation data were used to identify strategies to optimize patient coping and reduce caregiver burnout. At 16-months post-stroke, persistent amnesia and reduced emotional lability were reported by her family.
CONCLUSIONS: This case highlights the presence and need to characterize cognitive and behavioral deficits following bilateral thalamic infarction. Additionally, this case demonstrates the role of neuropsychology in characterization of cognitive and neuropsychiatric sequelae, including identification of relevant interventions/recommendations to inform treatment planning.
摘要：
目的：由于Percheron动脉闭塞（AOP）引起的双侧丘脑梗塞很少见（占所有缺血性中风的0.01-2％），神经心理学后遗症尚不明确。我们提出一个50岁的案例，右撇子,高加索女人,经过12年的教育，AOP卒中后出现认知和行为症状。
方法：AOP中风后，患者经历了7天的住院和1个月的亚急性康复.后者出院后的症状包括垂直凝视麻痹，轻度平衡困难，冲动,和健忘症（逆行和顺行）。与中风后五天的神经影像学相比，3个月时随访影像学显示双侧丘脑脑软化(图1),以及双侧小脑梗塞。中风后六个月咨询神经心理学以评估持续的认知和情绪/行为症状。
结果:(测试结果见表1)。测试结果显示平均估计的病前功能，健忘症（顺行和逆行）和执行功能障碍（包括情绪不稳定，刺激约束行为)，这干扰了处理速度和言语流畅任务的表现。注意,工作记忆,核心语言/视觉空间技能得以幸免。这些症状导致心理压力的导航困难/恶化，并需要日常功能的外部支持。神经心理学评估数据用于确定优化患者应对和减少护理人员倦怠的策略。中风后16个月,她的家人报告了持续的健忘症和情绪低落。
结论：该病例强调了双侧丘脑梗死后认知和行为缺陷的存在和需要。此外,这个案例证明了神经心理学在表征认知和神经精神后遗症中的作用，包括确定相关干预措施/建议以告知治疗计划。
方法：AOP中风后，患者经历了7天的住院和1个月的亚急性康复.后者出院后的症状包括垂直凝视麻痹，轻度平衡困难，冲动,和健忘症（逆行和顺行）。与中风后五天的神经影像学相比，3个月时随访影像学显示双侧丘脑脑软化(图1),以及双侧小脑梗塞。中风后六个月咨询神经心理学以评估持续的认知和情绪/行为症状。
结果:(测试结果见表1)。测试结果显示平均估计的病前功能，健忘症（顺行和逆行）和执行功能障碍（包括情绪不稳定，刺激约束行为)，这干扰了处理速度和言语流畅任务的表现。注意,工作记忆,核心语言/视觉空间技能得以幸免。这些症状导致心理压力的导航困难/恶化，并需要日常功能的外部支持。神经心理学评估数据用于确定优化患者应对和减少护理人员倦怠的策略。中风后16个月,她的家人报告了持续的健忘症和情绪低落。
结论：该病例强调了双侧丘脑梗死后认知和行为缺陷的存在和需要。此外,这个案例证明了神经心理学在表征认知和神经精神后遗症中的作用，包括确定相关干预措施/建议以告知治疗计划。
