Role of neurorehabilitation in the recovery of bilateral thalamic stroke related to the artery of Percheron anatomical variant

Abstract

Bilateral thalamic stroke is a rare condition, mostly related to the presence of the artery of Percheron (AoP) variant. The clinical presentation of AoP-related strokes is remarkably heterogeneous and often includes cognitive and behavioural alterations. Our report describes the clinical course of an AoP-related bilateral thalamic stroke and highlights the pivotal role of a tailored rehabilitation programme plays in enhancing recovery. A man in his 40s was admitted to the neurology ward due to the abrupt onset of mental status alterations and weakness in his left limbs. The first brain CT scan and subsequent MRI exam revealed a bilateral thalamic stroke and the presence of an AoP anatomical variant. After the first critical phase, the patient's condition became stable, but he still suffered from severe attention, memory and speech deficits. The patient was then transferred to the rehabilitation unit and was subjected to a tailored neurorehabilitation programme that allowed a complete recovery of the symptoms. Neurorehabilitation plays a pivotal role in the patient's recovery and should always be pursued to minimise the residual deficits and, most importantly, to prevent permanent cognitive deficits.

Keywords: Memory Disorders; Neuroimaging; Stroke.

Figure 1

Axial sections of the patient’s MRI brain scan (fluid-attenuated inversion recovery sequence) performed 1 week after admission. The figure shows the territories bilaterally damaged by the occlusion of the Aartery of Percheron (A=rostral view, B= caudal view). The medial thalamic nuclei are the most affected areas (right>left, black arrows).