Sequential Thalamic Hemorrhage and Ischaemia in the Percheron Artery Territory

An 84-year-old woman was found with an altered mental status and right hemiparesis. She had CHF, hypertension and hyperlipidemia under adequate pharmacologic treatment. An initial CT (Figure 1A) showed a left paramedian thalamic hemorrhage with mass effect over the third ventricle (arrow). Her blood pressure on admission was 190/100 mmHg requiring IV labetalol and sodium nitroprusside for control. Her EKG revealed AF and the general laboratory results were normal including sed rate. Transcranial doppler results did not reveal abnormal velocities suggestive of stenosis in the posterior circulation. At 72 hrs from admission her mental status deteriorated and a new CT (Figure 1B) did not show hydrocephalus or significant changes in the hemorrhage although a new hypodensity was observed in the right paramedian thalamic territory. On J of Neuroimaging in Psychiatry & Neurology