Sudden Onset Altered Sensorium: Artery of Percheron Infarct

Abstract

Acute onset Altered mental status is a common but clinically challenging emergency due to numerous possibilities with little clinical window and time to treat. The numerous causes include stroke, encephalitis, organ dysfunction, metabolic, endocrine and intoxication. Amongst the vascular causes, one rare but peculiar cause being artery of percheron infarct. Blood supply to the thalamus and brainstem have various anatomic variations. Artery of Percheron is one such variation in which a single arterial trunk arises from proximal segment of one of the posterior cerebral artery (PCA) and bifurcates to supply bilateral paramedian thalami. Occlusion of this artery, although uncommon results in characteristics pattern of symmetric infarction in bilateral medial thalami with or without mesencephalic infarction. We here describe a case of a gentleman who presented with sudden onset altered mental status and skew deviation. After improvement in sensorium characteristic vertical gaze palsy was noted with subtle confusion which recovered. MRI brain revealed characteristic Para median bithalamic infarcts with normal intracranial angiogram. Patient showed a slow and incomplete clinical recovery to conservative management.

Bilateral thalamic stroke due to occlusion of the artery of Percheron: A case report and literature review

“…Sequelae of bilateral infarction in the paramedian thalamic region have been reported to include decreased levels of consciousness, alterations in mental status, apathy, memory loss, difficulty with language (aphasia), speech difficulties (dysarthria), motor deficits, and disinhibited behaviors 6–8 . If the entire midbrain is affected, this leads to mesencephalothalamic or thalamopeduncular syndrome, which can include other oculomotor disorders and the involvement of long motor pathways 9–12 …”

“…[6][7][8] If the entire midbrain is affected, this leads to mesencephalothalamic or thalamopeduncular syndrome, which can include other oculomotor disorders and the involvement of long motor pathways. [9][10][11][12] The diagnosis of AOP occlusion relies on cerebral imaging studies, primarily MRI, since CT findings may appear normal. 13 To identify AOP infarct early on, FLAIR and diffusion-weighted imaging are the preferred imaging techniques.…”

Unveiling Rare Neurovascular Complexity; A Rare Bilateral Thalamic Infarction Case Report and Concise Literature Review

“…Sequelae of bilateral infarction in the paramedian thalamic region have been reported to include decreased levels of consciousness, alterations in mental status, apathy, memory loss, di culty with language (aphasia), speech di culties (dysarthria), motor de cits, and disinhibited behaviors (6-8). If the entire midbrain is affected, this leads to mesencephalothalamic or thalamopeduncular syndrome, which can include other oculomotor disorders and the involvement of long motor pathways (9)(10)(11)(12).…”