Posterior cerebral artery embolism resulting in bilateral paramedian thalamic infarction: A case report

Bilateral thalamic infarcts are not easily recognized, it have diverse clinical manifestations and relatively severe symptoms. It may leave long-term drowsiness, cognitive impairment, and speech impairment. We report a case of bilateral paramedian thalamic infarction with impaired consciousness as the main symptom. The digital subtraction angiography suggested that the left superior cerebellar artery and posterior cerebral artery (PCA) were occluded. PATIENTS CONCERN: A previously 67-year-old man was taken to our hospital after 9.5 hours of acute dizziness and loss of consciousness. DIAGNOSIS: The cranial DWI + MRA suggested acute cerebral infarction in bilateral thalamus and bilateral midbrain, and the left posterior cerebral artery was not clearly visualized. The patient was diagnosed with posterior cerebral artery embolism. INTERVENTIONS: A mechanical thrombectomy was performed. OUTCOME: The patient’s symptoms did not completely improve after revascularization, followed by fluctuating consciousness. LESSONS: Recurrent lethargy in patients after endovascular treatment may be a clinical manifestation of damage to thalamic structures or due to the presence of ineffective recanalization.