Artery of Percheron Infarct: 12 Cases and Their Complex Clinical Courses

Abstract

Strokes involving the artery of Percheron (AOP), an anatomic variant of thalamic vascular supply, are rare. Little is known about the inpatient hospital course for these patients. We retrospectively identified consecutive patients with AOP in their medical charts from a university-based tertiary care hospital from January 1, 2000, to August 15, 2017. A chart review identified demographics, transfer status, in-hospital versus community onset of stroke, emergency medical services (EMS) use, presenting signs/symptoms, time to radiologic diagnosis (from time of presentation to tertiary care hospital or from time of initial symptom onset in an already hospitalized patient), tissue plasminogen activator (tPA) use, intensive care unit (ICU) stays, intubation, length of stay (LOS), and discharge location. After radiologic inclusion/exclusion criteria were applied, 12 patients were included in the study. There were 7 men and 5 women, and the mean age (SD) was 68 (15). Seven were transfers, and 4 had an in-hospital stroke. Of the 8 community-onset strokes, 7 utilized EMS. Mental status changes occurred in 11 of 12 and ocular disturbances in all patients. Time to radiologic diagnosis averaged 1.9 (median = 1.1) days. One patient received tPA. Eight received care in the ICU. Four were intubated. Average LOS was 8.3 days. Four were discharged home, 3 entered inpatient rehabilitation facilities, and 5 entered skilled nursing facilities. In-hospital stroke status further complicates the already challenging diagnosis of AOP infarct, and clinicians must maintain a high suspicion for this rare stroke in order to quickly diagnose and intervene.

Bilateral thalamic infarction secondary to artery of Percheron occlusion: A rare cause of acute coma

“…This was followed by hemisyndromes, cognitive deficits, oculomotor nerve palsy, vertical gaze palsy, and aphasia. [7] Due to this variability in presentation the differential diagnosis is broad with AOP occlusion, top of the basilar artery syndrome, and deep cerebral venous thrombosis as the leading differential diagnosis. [1] Unfortunately, traditional vascular CT angiography does not routinely demonstrate the small perforating AOP vessel as evident in this patient in which a head CT and CT angiography revealed no evidence of infarction or occlusion.…”

Artery of Percheron Stroke as an Unusual Cause of Hypersomnia: A Case Series and a Short Literature Review

“…Firstly, the latter can occur at any age, but it is particularly common in patients after their 30s mostly between 60 and 70 years (Lin et al, 2018). Secondly, there is a slight male predominance with a male to female ratio of 3:2 (Hermann et al, 2008;Stamm et al, 2018;Suzuki et al, 2016).…”

Stroke Involving the Percheron Artery: A Rare Anatomical Variant

“…Artery of Percheron infarcts is rare. It typically presents with altered mental status, hemiplegia and gaze palsy [5], but because of complex anatomy and different variants of posterior cerebral circulation, ischemic infarcts in this territory usually present with variable and non-specific symptoms, which often delays the clinical diagnosis [5,6]. An initial head CT scan in most cases of artery of Percheron strokes shows no ischemia [7,8].…”