Artery of Percheron infarction: review of literature with a case report

Abstract

Background.Clinical features indicating an ischemic infarction in the territory of posterior cerebral circulation require a comprehensive radiologic examination, which is best achieved by a multi-modality imaging approach (computed tomography [CT], CT-perfusion, computed tomography angiography [CTA], magnetic resonance imaging [MRI] and diffusion weighted imaging [DWI]). The diagnosis of an acute ischemic infarction, where the damage of brain tissue may still be reversible, enables selection of appropriate treatment and contributes to a more favourable outcome. For these reasons it is essential to recognize common neurovascular variants in the territory of the posterior cerebral circulation, one of which is the artery of Percheron.Case report.A 69 year-old woman, last seen awake 10 hours earlier, presented with two typical clinical features of the artery of Percheron infarction, which were vertical gaze palsy and coma. Brain CT and CTA of neck and intracranial arteries upon arrival were interpreted as normal. A new brain CT scan performed 24 hours later revealed hypodensity in the medial parts of thalami. Other imaging modalities were not performed, due to the presumption that the window for the application of effective therapy was over. The diagnosis of an artery of Percheron infarction was therefore made retrospectively with the re-examination of the CTA of neck and intracranial arteries.Conclusions.A multi-modality imaging approach is necessary in every patient with suspicion of the posterior circulation infarction immediately after the onset of symptoms, especially in cases where primary imaging modalities are unremarkable and clinical features are severe, where follow-up examinations are indicated.

Paramedian Thalamic Ischemic Infarction: A Retrospective Clinical Observation

“…In our study, we noted that it was only 4 of 9 in patients with bilateral infarcts, and 8 of 12 in patients with unilateral paramedian thalamic infarcts, but selective gaze palsy was not recorded. It was reported that 39.2-60% patients with bithalamic paramedian infarcts had memory impairment [12,13]. Only 1 patient with bilateral paramedian thalamic lesion in our cases complained of memory impairment, while 3 patients with unilateral lesions showed memory impairment.…”

“…Top of basilar syndrome has a similar clinical pattern when compared with that of thalamic paramedian infarct [13]. Abnormal pupillary reflex is suggestive of the midbrain damage.…”

Fluctuating drowsiness following cardiac catheterisation: artery of Percheron ischaemic stroke causing bilateral thalamic infarcts

“…This may ultimately delay diagnosis and treatment. CT brain, especially in the acute phase, will often not identify the lesion; therefore MRI should be considered at the earliest opportunity to expedite a diagnosis, as this has a higher diagnostic yield than CT 20 23 24…”

Artery of Percheron: an unusual stroke presentation

“…Characterised by a single trunk arising from a proximal segment of either of the two posterior cerebral arteries, it supplies the paramedian thalami and the rostral midbrain bilaterally. Clinical features of AOP ischaemic stroke vary hugely due to the complex functions of the human thalamus and midbrain structures, but there are three main features: vertical gaze palsy, memory impairment and coma 2. This case report draws attention to a rare form of stroke whose presentation can mimic many other conditions, including seizures.…”