The abdominal aortic aneurysm (AAA) is a vascular condition that commonly affects individuals over the age of 65, leading to complications such as rupture, thrombosis, and embolization that can result in significant morbidity and mortality. Aorto-enteric fistula (AEF), a rare but life-threatening complication of abdominal aortic aneurysms, occurs when there is communication between the aneurysm and adjacent bowel loops. A 63-year-old man presented to the emergency department (ED) with severe abdominal pain, nausea, vomiting, and dark, tarry stools. Prior to his current presentation, the patient sought medical care from several primary care centers for vague abdominal pain that was diagnosed as dyspepsia, and he was prescribed omeprazole. During the current presentation, the patient had hemodynamic instability and a diffusely tender abdomen. Subsequently, a computed tomography (CT) scan revealed an abdominal aortic aneurysm with AEF. Although the patient underwent exploratory laparotomy, he suffered cardiac arrest and ultimately died in the operating room. This case underscores the importance of early recognition and management of AEF, which is crucial for improving patient outcomes.

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.