BMJ Case Reports 2017; doi:10.1136/bcr-2016-218035

Fluctuating drowsiness following cardiac catheterisation: artery of Percheron ischaemic stroke causing bilateral thalamic infarcts

  1. Nabarun Sengupta3
  1. 1Cardiology Department, Western Sussex Hospitals NHS Trust, Worthing, UK
  2. 2Radiology Department, Western Sussex Hospitals NHS Trust, Worthing, UK
  3. 3Department of Stroke and Elderly Care, Western Sussex Hospitals NHS Trust, Worthing, West Sussex, UK
  1. Correspondence to Dr Daniel Hammersley, djhammersley{at}
  • Accepted 10 December 2016
  • Published 2 January 2017


An 81-year-old man underwent cardiac catheterisation to investigate breathlessness and left ventricular impairment of unknown cause. He had unobstructed coronary arteries. Immediately following the procedure, he became suddenly unresponsive with vertical gaze palsy, anisocoria and bilateral upgoing plantar responses. He made a rapid recovery to his premorbid state 25 min later with no residual focal neurological signs. He then had multiple unresponsive episodes, interspaced with complete resolution of symptoms and neurological signs. MRI of the brain identified bilateral medial thalamic infarcts and midbrain infarcts, consistent with an artery of Percheron territory infarction. By the time the diagnosis was reached, the thrombolysis window had elapsed. The unresponsive episodes diminished with time and the patient was discharged to inpatient rehabilitation. At 6-month review after the episode, the patient has a degree of progressive cognitive impairment.


  • Contributors DH wrote the body of the text. AA provided the MRI images and pictorial illustration with captions. MD provided structural guidance and edited final draft. NS gave structural and stylistic guidance and edited final draft.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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