Acute percheron infarction: a precision learning

Abstract

Background So far, the diagnosis of acute artery of percheron (AOP) infarction is uncommon. In this study, patients with acute AOP infarction were studied to explore the relationship of imaging findings, clinical manifestations and prognosis of acute AOP infarction. Materials A total of 23 patients with acute AOP infarction in our institution from 2014 to 2019 were reviewed retrospectively. All cases were evaluated by computed tomography (CT) and magnetic resonance imaging (MRI). The modified Rankin scale (MRS), blood examination, electrocardiogram and transthoracic echocardiography were used for detailed clinical and prognostic evaluation. All standard risk factors for these patients were recorded. The MRS scores were performed 90 days after discharge. Results Four different types of acute AOP infarction were identified: (a) bilateral paramedian thalamic infarction (BPTI, 52%); (b) bilateral paramedian thalamic with rostral midbrain infarction (BPTRMI, 30%), (c) bilateral paramedian and anterior thalamic infarction (BPATI, 13%), and (d) bilateral paramedian thalamic with red nuclei infarction (BPTRNI, 4%). These patients had consciousness disorder, memory dysfunctions, vertical gaze paresis and mesencephalothalamic syndrome. The 65% of patients with BPTI and BPATI experienced relatively good functional recovery and could carry out daily life activities (MRS score ≤ 2). However, patients with BPTRMI may have an unfavorable outcome. Conclusions Although the clinical features are variable, DWI or ADC map can improve the diagnosis of acute AOP infarction patterns. Acute AOP occlusion requires immediate diagnosis and treatment to obtain more favorable outcome and avoid additional unnecessary procedures.

Decoding Altered Consciousness: An Artery of Percheron Stroke

“…According to Zhang et al, patients with BPT and BPAT patterns of AOP infarctions demonstrated a good prognosis and meaningful recovery with appropriate treatment. However, this is not the case with the BPTRM counterpart [ 8 ], which was unfortunately present in our patient.…”

“…However, clinical presentations may vary due to the disparate functions of the implicated structures. Further described manifestations include vertical gaze palsy and ataxia (commonly seen with midbrain involvement), behavior and memory deficits (often associated with disruptions to the hippocampus or its connections), motor dysfunction, and speech difficulties [ 3 , 8 , 9 ]. It is noteworthy that in clinical practice, associating the symptoms with the underlying infarction/lesion poses a significant challenge to physicians.…”

A Case Series of Four Patients with Artery of Percheron Occlusion over a Three-Month Period

“…Thrombolysis in AOP occlusion has been shown to be beneficial before. In a series of 23 patients presented by Zhang et al [19], 6 patients received thrombolysis and all of them had a good outcome at 90 days (mRS ≤ 2). However, none had additional involvement of the midbrain, as seen in our case 4.…”

A case of Bilateral anterior thalamic symmetrical infarction

“…There may be several reasons for the patient to have bilateral anterior thalamus infarction at the same time. Some literature reports that in a few patients, bilateral or unilateral thalamic nodular arteries are absent, and blood is supplied by the parathalamic median artery [7] . The fourth type of Percheron infarction is bilateral parathalamic median area combined with anterior thalamic infarction [8] .…”