Department of Neurology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY Corresponding author: Darwin Ramirez-Abreu, M.D., e-mail: darwin.abreu{at}downstate.edu To the Editor: This letter reports on an 86-year-old man presenting with sudden-onset fluctuating confusion, disorientation, and aphasia. Brain imaging revealed acute infarcts in the medial aspects of both thalami, presumed to be caused by occlusion of the artery of Percheron. Infarcts in strategic regions of the brain are able to cause significant, acute cognitive impairment. We present an 86-year-old man with hypertension and chronic kidney disease, presenting with 2 days of sudden-onset, fluctuating confusion. The patient was otherwise healthy before the event, being able to take care of his or her own activities of the daily living (ADLs). On exam, he was awake, poorly attentive, minimally verbal, following simple commands intermittently, disoriented, and able to write only his name. The cranial nerves and sensory-motor exams were unremarkable. The results for complete blood count, blood chemistries, urinalysis, and urine toxicology were unremarkable. Computed tomogram of the head without contrast showed well-demarcated hypodense areas in the medial aspects of both thalamic (not shown). Magnetic resonance image (MRI) confirmed the presence of acute infarcts in the medial aspects of
Rapid-Onset Cognitive Impairment Due to Bilateral Medial-Thalamic Infarcts
Abstract
Department of Neurology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY Corresponding author: Darwin Ramirez-Abreu, M.D., e-mail: darwin.abreu{at}downstate.edu To the Editor: This letter reports on an 86-year-old man presenting with sudden-onset fluctuating confusion, disorientation, and aphasia. Brain imaging revealed acute infarcts in the medial aspects of both thalami, presumed to be caused by occlusion of the artery of Percheron. Infarcts in strategic regions of the brain are able to cause significant, acute cognitive impairment. We present an 86-year-old man with hypertension and chronic kidney disease, presenting with 2 days of sudden-onset, fluctuating confusion. The patient was otherwise healthy before the event, being able to take care of his or her own activities of the daily living (ADLs). On exam, he was awake, poorly attentive, minimally verbal, following simple commands intermittently, disoriented, and able to write only his name. The cranial nerves and sensory-motor exams were unremarkable. The results for complete blood count, blood chemistries, urinalysis, and urine toxicology were unremarkable. Computed tomogram of the head without contrast showed well-demarcated hypodense areas in the medial aspects of both thalamic (not shown). Magnetic resonance image (MRI) confirmed the presence of acute infarcts in the medial aspects ofPreview Only. This article cannot be rented because we do not currently have permission from the publisher.
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Rapid-Onset Cognitive Impairment Due to Bilateral Medial-Thalamic Infarcts
Ramirez-Abreu, Darwin G.; Law, Susan W.
Follow Journal of Neuropsychiatry & Clinical Neurosciences
, Volume 23 (3): E31
American Psychiatric Publishing, Inc (Journal) – Aug 1, 2011
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