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Figure 5: Magnetic resonance angiography showing patent basilar tip and
posterior cerebral arteries. (a) Anterior view; (b) lateral view right side

presentation. Long‑term anticoagulant therapy is the
current treatment strategy suggested for AOP occlusion. [7]

Figure 4: Magnetic resonance imaging brain T2‑weighted sequences showing In comparison to ischemic lesions of other
V‑shaped hyper‑intense signal areas in the pial surface of the midbrain
adjacent to the interpeduncular fossa without any abnormal signs in this region cortical‑subcortical structures, thalamic stroke has a
lower mortality rate and a better prognosis as far as the
[2]
impairment (58%), confusion (53%), and coma (42%). recovery of motor deficits is concerned. On the contrary,
Vertical gaze palsy is due to the disruption of the cortical the neuropsychological deficits in terms of memory,
input that traverses the thalamus to reach the rostral cognition, emotional response and behavior tend to
interstitial medial longitudinal fasciculus. Memory persist, and interfere with the social and professional life
[3]
impairment, confusion, and coma classically seen in of the patient.
bilateral thalamic infarction, often called together as
“thalamic dementia” is explained by the involvement In conclusion, occlusion of the AOP is a rare cause of coma
of the reticular activating system and the disrupted in elderly patients. Diffusion‑weighted MRI is the imaging
[4]
connections between the thalamus and the cortex. modality of choice for early diagnosis. Early diagnosis of
Thalamic dementia does not develop in case of unilateral AOP occlusion may lead to favorable outcomes.
lesions.
Financial support and sponsorship
These patients must be differentiated from those with Nil.
“top of the basilar artery” syndrome and deep cerebral
venous thrombosis (DCVT). [5,6] “Top of the basilar artery” Conflicts of interest
syndrome tends to involve the superior cerebellar artery There are no conflicts of interest.
and posterior cerebral artery territories. MRI showing
patent basilar tip and posterior cerebral arteries exclude REFERENCES
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16 Neuroimmunol Neuroinfammation | Volume 3 | Issue 1 | January 20, 2016