The Clinical and Cognitive Spectrum of Artery of Percheron Infarction: 1-Year Follow-Up

Abstract

Objective: Survivors of patients with artery of Percheron infarction (API) often have a prolonged and disabling form of cognitive impairment that remains insufficiently characterized. We aimed to examine the clinical and cognitive features of API in the short and long term after stroke. Methods: We reviewed 6400 patients with a first-ever stroke included in the Stroke Registry between 2011 and 2021. The diagnosis of API was based on clinical diagnosis and imaging confirmation. All patients underwent neuropsychological assessment at hospital stay and 1 year after stroke. A z-score of each patients’ cognitive test point was calculated, and a z-score inferior to 2 was considered as pathological. Results: Of the 10 patients enrolled, all had cognitive impairment, consciousness, and behavioral disorders at stroke onset. Six patients had pure bilateral thalamic involvement while four had bilateral thalamic and rostral midbrain involvement. At 12 months, 50% of patients had global mental state scores 2 SD below the population mean (z-score mean ± SD, −2.17 ± 0.4). Most of the prefrontal cortex cognitive processes including executive functions such as planning and cognitive control (z-score mean ± SD, −3.92 ± 0.3), processing speed (−4.42 ± 0.5), working memory (−3.97 ± 0.3) were severely impaired at stroke onset. Especially in patients with thalamic and rostral midbrain involvement, deficiencies in executive function (z-score mean ± SD, −2.60 ± 0.4), processing speed (−2.22 ± 0.5), working (−3.76 ± 0.4), and episodic memory (−2.23 ± 0.3) continued 12 months after stroke. Conclusions: The occlusion of the artery of Percheron results in severe behavioral and cognitive disorders in the short and long term after stroke.

Artery of Percheron Infarct: A Rare Case Presentation and Recovery

“…A 2014 study also found that, in 15 patients with AOP infarctions, mental status changes and oculomotor disturbances were the two most common findings [9]. These findings were corroborated in a separate stroke registry study that found 10 patients with AOP infarcts to have behavioral, cognitive, and consciousness disturbances at the onset of stroke [10]. However, studies report variations in symptoms in a spectrum of seven patterns as follows: mental status changes, aphasia, behavior/memory impairment, ocular movement abnormalities, cerebellar signs, motor deficits, and nonspecific signs, such as seizures, hyperthermia, and hypersomnia [8,11].…”

“…Further research is needed to clarify the true long-term prognosis of all four types of AOP infarctions. For patients with AOP infarctions that contain thalamic and midbrain involvement, there can be persistent long-term deficits in executive function and processing speed, as well as both working and executive memory one year after the infarction [ 10 ].…”

Role of neurorehabilitation in the recovery of bilateral thalamic stroke related to the artery of Percheron anatomical variant

“…A comparison with similar reports (table 2) shows that some degree of cognitive impairment is commonly observed after AoP strokes, particularly when no rehabilitation is performed or is delayed. Moreover, a systematic review on longitudinal trajectories of cognition after AoP stroke showed that 50% of the subjects had persistent and clinically relevant cognitive deficits after 1 year 28. In these patients, executive functions were the most affected initially, while episodic memory deficits were also observed 1 year later 28…”

“…Moreover, a systematic review on longitudinal trajectories of cognition after AoP stroke showed that 50% of the subjects had persistent and clinically relevant cognitive deficits after 1 year 28. In these patients, executive functions were the most affected initially, while episodic memory deficits were also observed 1 year later 28…”