Bithalamic Infarction (Artery of Percheron Occlusion) after Anterior Cervical Discectomy and Fusion

Abstract

Bithalamic infarction resulting from occlusion of the artery of Percheron after cervical spine surgery is a rare pathological entity. Diagnosis and early detection are challenging. Prompt management may help to improve the outcome. We present a case of a 39-year-old male patient, smoker, diagnosed with multiple cervical disc herniations, who underwent Anterior Cervical Discectomy and Fusion (ACDF) for C3-C4, C4-C5, and C5-C6. During the 2-hour and 50-minute surgery, the patient was lying supine with his neck hyperextended. The intraoperative procedure was uneventful. During surgery, blood pressure ranged around 110 mmHg∖50 mmHg. At the end of surgery, the patient’s recovery from general anesthesia was normal with no delaying or complication; on next the day, patient developed a sudden loss of consciousness. Urgent brain computed tomography (CT) was normal; two days later, follow-up CT and CT Angiography (CTA) revealed bilateral thalamic infarction with right vertebral artery occlusion from its origin. Intraoperative surgical manipulation, hypotensive anesthesia, and prolonged neck hyperextension might have contributed to stroke in this patient. ACDF carries a potential risk for posterior circulation stroke. Artery of Percheron infarction should be considered in the differential diagnosis of patients developing a sudden loss of consciousness after ACDF. Vertebral artery thrombosis should be taken into account as an important possible cause of embolism.