Ischemic Stroke of the Artery of Percheron with Normal Initial MRI: A Case Report

Abstract

The artery of Percheron is a solitary trunk representing an uncommon anatomic variant that provides bilateral arterial supply to the paramedian thalami and the rostral midbrain. Occlusion of this artery results in bilateral thalamic and mesencephalic infarctions. The clinical diagnosis is difficult because the complex anatomy causes large clinical variability. We report a case of a comatose patient with normal early head-computed tomography and magnetic resonance imaging. A bilateral paramedian thalamic infarct due to an occlusion of the artery of Percheron was revealed two days later by a new head computed tomography. To our knowledge, this is the first report in the literature of a symptomatic patient presenting an acute Percheron stroke with normal early brain magnetic resonance imaging. Our case indicates that a normal initial magnetic resonance imaging cannot formally eliminate the diagnosis of acute stroke of the artery of Percheron. We discuss the causes of noncontributive brain magnetic resonance imaging at the onset of this acute Percheron stroke and the alternative diagnosis and therapy methods.

Contemporary therapeutic strategies for occlusion of the artery of Percheron: a review of the literature

“…The small therapeutic window (4.5–6 h) of thrombolytic therapy, currently the most effective treatment for AOP occlusion, necessitates the importance of immediate diagnosis to maximize efficacy and minimize risk 11 22 23. The first known case of treated AOP occlusion proven by angiography was treated with tissue plasminogen activator thrombolysis delivered via catheterization, resulting in full patient recovery with residual absence of upgaze and downgaze, and skew deviation 24.…”

“…Intravenous heparin on day 2 after onset of unconsciousness, dysarthria, and other neurological abnormalities proved effective, and the patient was discharged with marked cognitive and motor improvement but still with partial memory deficit 22. Heparin has also been used post-recanalization with thrombolysis 24.…”

bilateral thalamic infarction with psychiatric symptoms: case report

“…Kumral ve ark, iskemik inmelerin %0.6'sını oluşturduğu bildirmişlerdir (9). Tüm talamik infarklar içinde bilateral talamik enfarkt oranı 22-35% arasındadır (10,11). Talamusun beslenmesinde dört ayrı vasküler alan bulunmaktadır: (1) tuberotalamik arter (polar arter) posterior kommünikan arterden (PComA) köken alır, (2) Psikiyatrik semptomların eşlik ettiği bilateral talamik enfarkt inferolateral (talamogenikülat) arterler ve (3) paramedian arterler (talamoperforan) posterior serebral arterin (PCA) P1 dalından köken alır, (4) posterior koroidal arterler PCA nın P 2 segmentinden köken alırlar (12).…”

“…Bilateral talamik enfarktda etyolojik olarak en sık neden kardiyoembolizmdir ve prognoz genellikle iyidir (10,11,20,21). Bizim olgumuzda SVH açısından herhangi bir etyolojik neden bulunamadı ve klinik olarak hızla düzeldi ve taburcu edildi.…”

Demencia secundaria a infarto talámico bilateral (Síndrome de Percheron): Reporte de un caso

“…El infarto talámico bilateral simultáneo es infrecuente; representa cerca del 0.6% del primer infarto cerebral agudo (2) y de 22 a 35% de todos los infartos talámicos (4,5). La arteria de Percheron corresponde a una variante de irrigación de la región paramediana de ambos tálamos, a partir de una única arteria paramediana de origen en el primer segmento (P1) de una de las arterias cerebrales posteriores (6) (Figura 2).…”