Status epilepticus as a presenting feature of bilateral paramedian thalamic and midbrain infarct-Artery of percheron infarct?

Seizures in stroke account for 11% cases of new onset seizure in adults. Risk factors for stroke associated seizures are cortical involvement, anterior hemisphere lesion, cardioembolic etiology. Seizure in case of thalamic or brainstem infarcts have rarely been described in literature and status epilepticus is very rare in these infarcts. Here we report a case of 40 years male patient who presented to emergency room with history of sudden onset vertigo and vomiting, followed by generalised tonic clonic seizures which evolved into status epilepticus. His magnetic resonance imaging of brain with diffusion weighted image (DWI) revealed acute infarct involving bilateral paramedian thalamic and midbrain region. Emergency physician should be aware of this atypical clinical scenario which can facilitate early diagnosis and treatment and thereby improve disease prognosis. (C) 2018 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.