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Key Clinical MessageThe artery of Percheron (AOP) infarction always manifests as paramedian bilateral thalamic infarcts and might present as paramedian midbrain infarcts. Despite the limited MRA evaluation, due to small size of the artery, careful evaluation of the patient's history, the clinical presentation with imaging findings can facilitate the proper diagnosis.

Cerebellar mutism syndrome (CMS) was first described by Rekate et al in 1985. This syndrome is a common complication of posterior fossa surgery in children with range of 11-29% and usually manifests as diminished speech, hypotonia, and ataxia. The cause is due to bilateral pertubation of the dentate nuclei and their efferent pathways by edema, perfusional defects, axonal damage or metabolic disturbances. Other rare causes of CMS like acute subdural hematoma of the posterior fossa, head injury, brainstem glioma surgery, meningitis and basilar artery occlusion have also been reported. CMS after supracerebellar resection of the pineal tumor is a very rare with very few cases reported. We report such a case in a 10-year old boy who underwent excision of a pineal tumor through the infratentorial supracerebellar route.