• Shaowei Xie, Ning Han, Xingyu Chen, Kuochang Yin, Guodong Xu, Yanhong Dong, and Peiyuan Lv.
• Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
• Medicine (Baltimore). 2022 Nov 25; 101 (47): e32071e32071.

RationaleBilateral 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 ConcernA previously 67-year-old man was taken to our hospital after 9.5 hours of acute dizziness and loss of consciousness.DiagnosisThe 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.InterventionsA mechanical thrombectomy was performed.OutcomeThe patient's symptoms did not completely improve after revascularization, followed by fluctuating consciousness.LessonsRecurrent lethargy in patients after endovascular treatment may be a clinical manifestation of damage to thalamic structures or due to the presence of ineffective recanalization.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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