Artery of Percheron: an unusual stroke presentation

Artery of Percheron Infarction: A Rare But Important Cause of Bilateral Thalamic Stroke

Artery of Percheron infarction is a serious but rare condition that can result in acute bilateral thalamic infarction and a wide range of neurological symptoms. It occurs due to occlusion of the single arterial branch that supplies the medial thalamus and rostral midbrain bilaterally. In this case report, we describe a 58-year-old female with a history of hypertension and hyperlipidemia who presented with sudden confusion, speech difficulties, and right-sided weakness. An initial CT scan showed ill-defined hypodensity in the left internal capsule, which, when combined with the clinical features, suggested acute ischemic stroke. The patient received an IV tissue plasminogen activator within the recommended time window. Several days later, repeated imaging showed bilateral thalamic hypodensity consistent with subacute infarction in the territory of the artery of Percheron. The patient was subsequently discharged to a rehabilitation facility for further recovery and rehabilitation with residual mild hemiparesis. It is important for healthcare providers to maintain a high index of suspicion for the artery of Percheron infarction and be aware of its potential to cause acute bilateral thalamic infarction and a variety of neurological symptoms.

Intravenous thrombolytic therapy for cerebral infarction due to the Persheron artery occlusion. Case report

Occlusion of the artery of Percheron is the cause of bilateral thalamic infarctions, sometimes involving structures of the midbrain. A clinical case of intravenous thrombolytic therapy for ischemic stroke due to the occlusion of the Percheron artery in a 72-year-old female patient who developed depression of consciousness, oculomotor disorders, dysarthria, ataxia, pyramidal disorders, and cognitive disorders is presented. Magnetic resonance imaging, which detected bilateral thalamus paramedian infarction in the acute stage, made it possible to diagnose the occlusion of the Percheron artery. Intravenous thrombolysis led to a rapid regression of symptoms; at the end of the acute period of the disease, the patient was discharged from the hospital with a slight neurological deficit and with a good functional outcome. After a one year the dynamic observation revealed persistent mild cognitive disorders; magnetic resonance imaging showed small symmetric cystic-gliosis changes in the medial parts of the thalamus on both sides. Timely diagnosis and intravenous thrombolytic therapy contribute to a good outcome of cerebral infarction due to the Percheron's artery occlusion.

A Case of Diagnostic Difficulty: Transient Loss of Consciousness in Artery of Percheron Infarct

The artery of Percheron (AOP) is a rare anatomical variant of the paramedian thalamic vessels in 7-10% of the general population. An AOP infarct can present with rare clinical manifestations like transient loss of consciousness (LOC) and lethargy, as was seen in the patient whose case is discussed in this report, due to the plethora of regulatory inputs and outputs by the thalamus, which cannot be compensated for because of the absence of anastomotic connections. The AOP supplies the reticular activating system (RAS), which regulates consciousness. Ischemia to this area from an AOP infarct can result in the transient LOC, which our patient experienced. The AOP is a small vessel that is often missed on a CT angiogram (CTA) alone due to low resolution. As a result, it is imperative that clinicians utilize MRI to diagnose AOP infarcts in patients who present with symptoms that raise concerns for decreased bilateral thalamic function and transient LOC.

Artery of Percheron infarction results in severe bradycardia: A case report

Background:

The thalamus is normally supplied by each posterior cerebral artery (PCA). The artery of percheron is a variant of this anatomy as it arises as a single trunk unilaterally from the PCA to supply the thalamus bilaterally. Occlusion of this artery is rare, and the diagnosis is usually missed without obtaining an MRI.

Case Description:

We illustrate the case of a 68-year-old male who presented with coma, ocular gaze palsy, and severe bradycardia from bilateral thalamic nuclei and midbrain infarction, as described as an artery of Percheron infarction. The patient recovered neurologically under conservative treatment with a residual vertical diplopia from downward gaze palsy. He underwent cardiac pacer implantation for severe bradycardia at the end of his admission. The thalamic pathway associated with cardiac rhythm, especially the zona inserta, is discussed. Publications related to the artery of Percheron are reviewed.

Conclusion:

Coma and ocular gaze palsy are the most common presentations following thalamic and midbrain ischemia from artery of Percheron infarction. To our knowledge, only a single case of artery of Percheron infarction with severe bradycardia has been reported in the past. Our case attested the role of thalamic nuclei controlling cardiac rhythm.