Assessment of Percheron infarction in images and clinical findings

Xu, Zhihua; Sun, Lixian; Yang, Dan; Zhang, Jinghua; Zhang, Mengzhi; Cai, Xiaobo

doi:10.1016/j.jns.2017.10.033

Cited by 35 publications

(57 citation statements)

References 20 publications

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“…The risk factors of the artery of Percheron occlusion are similar to the ones of an ischemic stroke: small vessel disease (33-38.9%); cardioembolic source (0-22%); large vessel disease (13.2-22.2%); other causes like vasospasm secondary to subarachnoid hemorrhage, hemodynamic alterations, vascular dissection, distal ischemia of the PCA, aneurysms of the basilar artery, hypercoagulable states and vasculitis secondary to infections of the central nervous system (13-15.7%); and idiopathic causes (10%) [ 1 , 7 - 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Bilateral Thalamic Ischemic Stroke Secondary to Occlusion of the Artery of Percheron

García‐Grimshaw¹,

Peschard-Franco

Gutiérrez-Manjarrez

2018

Cureus

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The occlusion of the artery of Percheron (AOP) is a rare condition that causes bilateral thalamic ischemic stroke with or without midbrain involvement. It happens as a result of an anatomical variant of the diencephalic irrigation, in which the thalamic paramedian arteries arise from a common trunk from the posterior cerebral artery (PCA), which generates a clinical syndrome characterized by bilateral vertical gaze palsy, memory impairment and hypersomnia. In this case, we report a 62-year-old woman admitted to the emergency room with altered mental status, mainly somnolence. On physical examination, she was somnolent, apathetic and with no motor deficit. Magnetic resonance imaging (MRI) of the brain demonstrated bilateral thalamic hyperintensities and midbrain involvement in diffusion-weighted imaging (DWI) and T2 sequences, suggesting occlusion of the AOP. Bilateral thalamic infarction due to this anatomical variant is an entity with a low prevalence, and its diagnosis can be delayed because of the wide spectrum of clinical signs.

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Section: Discussionmentioning

confidence: 99%

“…Neuropsychiatric changes like apathy and aggressiveness have been observed. There is a report of two cases in which the diagnosis was confused with conversion disorders [ 7 , 10 - 12 ].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Thalamic Ischemic Stroke Secondary to Occlusion of the Artery of Percheron

García‐Grimshaw¹,

Peschard-Franco

Gutiérrez-Manjarrez

2018

Cureus

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“…Most significative case series of thalamic strokes were analyzed by Lazzaro (2010) [ 27 ], Jiménez Caballero (2010) [ 26 ], Song (2011) [ 29 ], Arauz (2014) [ 30 ], Förster (2014) [ 31 ], and Xu (2017) [ 32 ]. There were described four clinical and radiological topographic patterns of infarcts: bilateral paramedian thalamic with midbrain involvement (43%), as in the present case report; only bilateral paramedian thalamic without midbrain lesions (38%); bilateral paramedian thalamic associated with involvement of the anterior thalamus and midbrain (14%); and bilateral paramedian thalamic and anterior thalamus infarction, without midbrain involvement (5%) [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Uncommon Association of Two Anatomical Variants of Cerebral Circulation: A Fetal-Type Posterior Cerebral Artery and Inferred Artery of Percheron, Complicated with Paramedian Thalamomesencephalic Stroke—Case Presentation and Literature Review

Anghelescu

2018

Case Reports in Neurological Medicine

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Background The unilateral fetal variant of the posterior cerebral artery (FPCA) is characterized by the congenital absence of the P1 arterial segment. The artery of Percheron (AOP) is an uncommon vascular variant, in which a single dominant thalamoperforating arterial trunk arises from one P1 segment, bifurcates, and provides bilateral supply to the paramedian thalami and rostral midbrain. Case Presentation This is a retrospective case study of a 37-year-old man with multiple lifestyle risk factors (chronic marijuana and tobacco abuse), who suffered a thalamomesencephalic stroke, rapidly worsening to comatose state. After restoration of consciousness, he clinically manifested with left paramedian midbrain syndrome. Imaging demonstrated an asymmetric paramedian thalamic infarction with mesencephalon extension, patency of the basilar, vertebral arteries, and left PCA and right-sided FPCA, respectively. Left-sided thalamoperforating arterioles were not differentiated; AOP was inferred. Neither evident clinical source of embolus nor prothrombotic states were found. Mobile cardiac telemetry and transesophageal echocardiography were not available. The diagnosis was established too late for thrombolytic treatment. Anticoagulation was indicated during the acute and subacute stages, followed by low dose of antiplatelet. Discussion This uncommon cerebrovascular configuration (FPCA+AOP) might be the fourth case described in the literature. Sustained rehabilitation and abstinence from tobacco and cannabis led to favorable outcomes.

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“…If the AOP occlusion is hyperacute to acute, noncontrast head CT will often be normal (Figure ) . In the late acute to subacute phase, decreased density compared with gray and white matter representing cytotoxic edema is present in the bilateral paramedian thalamic distribution.…”

Section: Imagingmentioning

confidence: 99%

“…If the AOP occlusion is hyperacute to acute, noncontrast head CT will often be normal (Figure 1). 7 In Figure 2 (B,C) shows a filling defect in the P1 segment of the left posterior cerebral artery (PCA) (solid arrow) representing either occlusive embolus or thrombus likely at the origin of the artery of Percheron (AOP) resulting in the acute infarct. Note normal P1 segment of the right PCA (dashed arrow).…”

Section: Computed Tomography (Ct): Noncontrast Ct and Ct Perfusionmentioning

confidence: 99%

Artery of Percheron Stroke: Imaging and Clinical Findings

O’Reilly

Mogensen

2019

PM&R

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Assessment of Percheron infarction in images and clinical findings

Cited by 35 publications

References 20 publications

Bilateral Thalamic Ischemic Stroke Secondary to Occlusion of the Artery of Percheron

Bilateral Thalamic Ischemic Stroke Secondary to Occlusion of the Artery of Percheron

Uncommon Association of Two Anatomical Variants of Cerebral Circulation: A Fetal-Type Posterior Cerebral Artery and Inferred Artery of Percheron, Complicated with Paramedian Thalamomesencephalic Stroke—Case Presentation and Literature Review

Artery of Percheron Stroke: Imaging and Clinical Findings

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