This is an elderly patient who was found unconscious at home. CT of the head without contrast was unremarkable, while CT angiography of the head and neck revealed a subocclusive thrombus on the precommunicating (P1) segment of the left posterior cerebral artery (PCA). MRI brain revealed bilateral regions of diffusion restriction in the paramedian thalami and bilateral medial mesencephalon. Initial angiography confirmed the presence of a subocclusive thrombus in the P1 segment of the left PCA. Thrombectomy was performed achieving recanalisation of the left PCA and reperfusion of bilateral thalami via a visualised artery of Percheron. Postoperatively, the patient was kept on a daily dose of 325 mg of aspirin. The patient did not improve neurologically. A follow-up MRI brain showed diffusion restriction in the left occipital lobe and petechial haemorrhages in the bilateral thalami. The family eventually opted for palliative measures, and the patient expired on day 14 of admission due to acute respiratory failure from palliative extubating.
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Contributors Dr HS and Dr AAB were part of the medical team managing the patient. Dr HS is the corresponding author and planned the outline for the discussion section in addition to overseeing the full process of putting the case ideas together in a cohesive manner. Dr SE performed full literature review and wrote the first full draft of the manuscript in addition to continuously updating the manuscript based on Dr AAB and Dr HS’s comments until the case report reached final version submitted. Dr AAB added essential and interesting elements in the case presentation in addition to guiding the literature review search. Dr AS reviewed the case adding formatting comments in addition to participating in writing of the summary paragraph.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer-reviewed.
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