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Abstract Details

An Uncommon Cause Of Bradycardia: Artery Of Percheron Infarct
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
241
To evaluate different clinical scenarios of artery of percheron infarct (AOP).
The AOP is an anatomic variant and its occlusion can present with different areas of involvement, including bilateral paramedian thalami with or without rostral midbrain infarct, or bilateral paramedian and anterior thalami with or without midbrain infarct. Animal models indicate that the zona incerta, insula, and the posterior part of the hypothalamus are interconnected and have a role in regulating cardiac rhythm. Connections between these structures and the thalamus may result in cardiac dysrhythmias.

A review of the medical literature using standard search engines was performed to locate articles regarding anatomic variants of AOP focusing in clinical presentations.

A 62-year-old man presented with gait ataxia, anisocoria, and left 3rd nerve palsy. Medical history of hypertension and tobacco use. Initial CT head and MRI brain were negative, after 12 hours he developed fluctuations of mental status with hypersomnolence, dysarthria, and bradycardia. Repeat MRI brain showed bilateral thalamic and midbrain strokes. Vessel imaging revealed P1 segment of posterior cerebral artery stenosis. He developed a new asymptomatic bradycardia with heart rate (HR) between 30-50 beats/min. Electrocardiogram showed sinus bradycardia at 44 bpm with no evidence of AV node block or ST/T changes. Echocardiogram showed LVEF of 70-74%, no thrombus or patent foramen ovale. Asymptomatic bradycardia was not related to any underlying heart disease or medication, thus, suggesting an etiology related to his particular ischemic lesions. Holter monitor per 10 days showed average HR of 48 beats/min with no dysrhythmia or AV node block. Pacemaker was not recommended.
To our knowledge there are only two cases in the literature describing bilateral anterior thalamic strokes and paramedian midbrain strokes associated with sinus bradycardia requiring pacemaker. This suggests that a midbrain-thalamic infarct requires appropriate cardiovascular monitoring to determine whether or not a pacemaker is needed.
Authors/Disclosures
Aaron Ravelo, MD (AHN)
PRESENTER 		Dr. Ravelo has nothing to disclose.
Varun Kumar Pala, MD Dr. Pala has nothing to disclose.
Rahul Chandra, MD Dr. Chandra has nothing to disclose.
David G. Wright, MD Dr. Wright has nothing to disclose.