Artery of Percheron infarction: Review of literature with a case report

Abstract

Background. The thalami and midbrain have a complex blood supply with a large number of variants. According to Percheron, there are four normal variants, in one of which the bilateral perforating thalamic arteries arise from a single arterial trunk called the artery of Percheron. An ischemic stroke in the territory of an artery of Percheron usually presents with three severe symptoms: vertical gaze palsy, memory impairment and coma. Infarction of an artery of Percheron presents as an abnormal signal on computer tomography (CT) and/or magnetic resonance imaging (MRI) involving the bilateral paramedian thalami with or without rostral midbrain involvement.

Case report. A 69 year-old Caucasian woman was found unresponsive in front of her apartment. Brain CT scan was normal, in particular without early signs of ischemia at the level of both thalami. A new brain CT scan was performed 24 hours later and showed symmetrical ill-defined areas of hypodensity in the medial part of both thalami corresponding to the occlusion of the artery of Percheron. On the basis of clinical, neuroimaging and neurovascular findings, the only possible diagnosis was an ischemic stroke in the territory of the artery of Percheron and the diagnosis was made retrospectively.

Conclusions. Diagnosing an artery of Percheron infarction is of vital importance for carrying out appropriate time sensitive management and preventing additional unnecessary procedures.