Transient side-changing hemispheric dysfunction: an unusual presentation of bilateral thalamic infarction mimicking large vessel occlusion

Excerpt

A 70-year-old woman referred to the Emergency Department (ED) of the Infermi Hospital in Rimini for the acute onset of blurred vision. At admission, 1 h after the onset of the blurred vision, she suddenly developed global aphasia, right gaze palsy, right hemiplegia with Babinski sign, right sensation loss, reduced consciousness, and left miosis (National Institute of Health Stroke Scale (NIHSS) = 23). Her past medical history was remarkable for arterial hypertension and atrial fibrillation. She was on rivaroxaban 20 mg daily. The clinical picture, localizing to the left hemisphere, along with the medical history, raised the suspicion of acute cerebrovascular disease due to intracranial hemorrhage or large vessel occlusion (LVO). Brain CT scan and CT angiography (CTA) ruled out intracranial hemorrhage, large vessel occlusion (LVO) in anterior and posterior arterial intracranial circulation, and intracranial/extracranial atherosclerotic disease (Fig. 1A, B). Electroencephalogram (EEG), performed to rule out a non-convulsive status epilepticus (NCSE), disclosed slow wave activity over the left hemispheric regions consistent with focal cerebral pathology (Fig. 1C).

…