Thalamic arteriovenous malformation fed by the artery of Percheron originating from the contralateral posterior cerebral artery in a child

Context: The Artery of Percheron (AOP) is an uncommon anatomic vascular variation derivated from posterior cerebral artery segment P1, wich branchs to irrigate bilaterally the thalamus in it is paramedian portion. Amidst vascular cerebral events of the ischemic type, thalamic infarction occour in 11% of the cases. The typical clinical presentation is constituted by the triad: cogniyivebehavior comitente, oculomotors and consience disturbs. Case report: J.F.M.L, 51 years old, male, was found unconscious in his residence by SAMU and then interned in Stroke Room of HGP in 02/06/2020 with a lowered level of consciousness (Glasgow 8). The tests demonstrated a bilateral thalamic infarct due to Artery of Percheron Ischemia. In 02/09/2020 it evolved into a Glasgow 9 being extubated. The CT after 3 days demonstrated absence of bleeding and prophylatically initiated simvastatin, clexane, physiotherapy and phonoaudiology. In 02/15/2020, during physical exam, the pacient was lucid, presented behavior alterations, had left cervical dystonia and ataxia. The patient progressed well and was discharged the next day. Conclusions: The AOP, when occluded, results in bilateral paramedian thalamic and the rostral midbrain infarctions wich may cause diagnosis issues, mainly because of the vast specter of diferential diagnosis. In the presence of triad signals characteritic of bilateral thalamic infarction in CT, it must suspect the manifestation of such entity.

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Progression of Stenosis Into Occlusion of the Distal Posterior Cerebral Artery Supplying an Occipital Arteriovenous Malformation Manifesting as Multiple Ischemic Attacks

Neurologia medico-chirurgica ◽

10.2176/nmc.52.899 ◽

2012 ◽

Vol 52 (12) ◽

pp. 899-902

Author(s):

Hisaharu GOTO ◽

Michiyasu SUZUKI ◽

Tatsuo AKIMURA ◽

Hirosuke FUJISAWA ◽

Hiroshi YONEDA ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Cerebral Artery ◽

Posterior Cerebral Artery

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Rapid arousal from anaesthesia after reversal of deep rocuronium-induced neuromuscular block with sugammadex in a neuroradiological procedure

BMJ Case Reports ◽

10.1136/bcr-2021-242820 ◽

2021 ◽

Vol 14 (8) ◽

pp. e242820

Author(s):

Matteo Giuffrida ◽

Nicola Susan Ledingham ◽

Paolo Machi ◽

Christoph Andreas Czarnetzki

Keyword(s):

Arteriovenous Malformation ◽

Cerebral Artery ◽

Brain Function ◽

Posterior Cerebral Artery ◽

Neuromuscular Block ◽

Effect Site ◽

Anaesthetic Depth ◽

Deep Neuromuscular Block ◽

The Right

We describe the case of a 42-year-old man undergoing elective embolisation of an arteriovenous malformation at the level of the right posterior cerebral artery under propofol anaesthesia. We used the SedLine Brain Function Monitor (Masimo) to titrate the anaesthetic depth with propofol. At the end of the procedure, the patient aroused from anaesthesia very rapidly after the reversal of deep neuromuscular block with sugammadex, despite still significant calculated doses of propofol at the effect site. This rapid arousal was monitored using the SedLine Brain Function Monitor.

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Transient coma as Percheron’s artery stroke

Journal of Health Sciences ◽

10.17532/jhsci.2019.696 ◽

2019 ◽

Author(s):

Maria sofia Cotelli ◽

Patrizia Civelli ◽

Elisa Tosana ◽

Marinella Turla

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Anatomic Variation ◽

Brain Structures ◽

Characteristic Pattern ◽

Caucasian Woman ◽

Arterial Trunk ◽

Artery Of Percheron ◽

The Brain ◽

Thalamic Infarcts

The artery of Percheron is a rare anatomic variation in the brain vascularization, in which a single arterial trunk arises from the posterior cerebral artery to supply both sides of brain structures, i.e., the thalamus and midbrain. Occlusion of this uncommon vessel results in a characteristic pattern of bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report the case of a Caucasian woman who completely recovers after transient coma due to Percheron artery infarction.

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Uncommon Association of Two Anatomical Variants of Cerebral Circulation: A Fetal-Type Posterior Cerebral Artery and Inferred Artery of Percheron, Complicated with Paramedian Thalamomesencephalic Stroke—Case Presentation and Literature Review

Case Reports in Neurological Medicine ◽

10.1155/2018/4567206 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Aurelian Anghelescu

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Retrospective Case ◽

Case Presentation ◽

Lifestyle Risk Factors ◽

Artery Of Percheron ◽

Thalamic Infarction ◽

Tobacco Abuse ◽

Lifestyle Risk ◽

Clinical Source

Background. The unilateral fetal variant of the posterior cerebral artery (FPCA) is characterized by the congenital absence of the P1 arterial segment. The artery of Percheron (AOP) is an uncommon vascular variant, in which a single dominant thalamoperforating arterial trunk arises from one P1 segment, bifurcates, and provides bilateral supply to the paramedian thalami and rostral midbrain. Case Presentation. This is a retrospective case study of a 37-year-old man with multiple lifestyle risk factors (chronic marijuana and tobacco abuse), who suffered a thalamomesencephalic stroke, rapidly worsening to comatose state. After restoration of consciousness, he clinically manifested with left paramedian midbrain syndrome. Imaging demonstrated an asymmetric paramedian thalamic infarction with mesencephalon extension, patency of the basilar, vertebral arteries, and left PCA and right-sided FPCA, respectively. Left-sided thalamoperforating arterioles were not differentiated; AOP was inferred. Neither evident clinical source of embolus nor prothrombotic states were found. Mobile cardiac telemetry and transesophageal echocardiography were not available. The diagnosis was established too late for thrombolytic treatment. Anticoagulation was indicated during the acute and subacute stages, followed by low dose of antiplatelet. Discussion. This uncommon cerebrovascular configuration (FPCA+AOP) might be the fourth case described in the literature. Sustained rehabilitation and abstinence from tobacco and cannabis led to favorable outcomes.

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Aneurysm Originating from the Fenestration of the Posterior Cerebral Artery: Case Report

Neurosurgery ◽

10.1097/00006123-200204000-00040 ◽

2002 ◽

Vol 50 (4) ◽

pp. 881-884 ◽

Cited By ~ 7

Author(s):

Tomomi Iwashita ◽

Yuichiro Tanaka ◽

Kazuhiro Hongo ◽

Jun-ichi Koyama ◽

Toru Koyama ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Cerebral Artery ◽

Clinical Presentation ◽

Posterior Cerebral Artery ◽

Middle Portion ◽

Lower Trunk ◽

Computed Tomographic ◽

Disturbance Of Consciousness ◽

One Year ◽

The Right

Abstract OBJECTIVE AND IMPORTANCE: A rare case of an aneurysm arising at the fenestration of the P2 segment of the posterior cerebral artery is reported. CLINICAL PRESENTATION: A 37-year-old man presented with severe headache and disturbance of consciousness. Computed tomographic scanning showed diffuse subarachnoid hemorrhage. Cerebral angiography revealed an aneurysm at the fenestration of the P2 segment of the right posterior cerebral artery. The aneurysm was located at the middle portion of the lower trunk of the fenestration. An unruptured arteriovenous malformation was incidentally found in the right thalamus. INTERVENTION: A right frontotemporal craniotomy with orbitozygomatic osteotomy was made, and the aneurysm was successfully clipped. One year after the operation, gamma knife surgery was performed for the right thalamic arteriovenous malformation. CONCLUSION: This is the first reported case of an aneurysm originating from the middle portion of a fenestrated posterior cerebral artery.

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Morphometry and anatomic variations of the posterior cerebral artery in Northeast Brazil

10.5327/1516-3180.336 ◽

2021 ◽

Author(s):

Andressa Gabriella Duarte de Queiroz ◽

Fábio Antônio Serra de Lima Júnior ◽

Júlio César Claudino dos Santos ◽

Larissa Eleutério Gomes ◽

Kauany Maia Ribeiro ◽

...

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Clinical Importance ◽

Circle Of Willis ◽

Northeast Brazil ◽

Anatomic Variations ◽

Artery Of Percheron ◽

Adult Pattern ◽

Human Brains ◽

Multiple Type

Introduction: The posterior cerebral artery (PCA) is a vessel of the Circle of Willis. Variations are observed in the first segments of the PCA and its branches, especially in the thalamoperforating arteries (TPAs) and in the artery of Percheron (AP). Anatomical presentation of these arteries is of relevant clinical importance for safer neurosurgical approaches. Objective: To identify the most frequent PCA and TPA patterns and the morphometry of P1 and P2 branches in Northeast Brazil. Methods: This is an observational study. Nine Circle of Willis from human brains were isolated. PCA morphology, TPAs classification and prevalence of AP were evaluated. The length and diameter of the P1 and P2 segments of the PCA were measured. Values of p 0.05). Conclusions: Adult pattern of PCA was the most frequent and trifurcation of PCA, a rare anomaly, was found in 22,2% of specimens. TPAs were mostly bilateral multiple type. No differences between sides in the length and diameter of the segments P1 and P2 were found. These data can contribute to safer approaches to neurological pathologies in this population in Northeast Brazil.

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Artery of Percheron occlusion with first-pass recanalisation of the first segment of posterior cerebral artery

BMJ Case Reports ◽

10.1136/bcr-2020-237968 ◽

2021 ◽

Vol 14 (4) ◽

pp. e237968

Author(s):

Sherif Elsayed ◽

Ali Al Balushi ◽

Alexander Schupper ◽

Hazem Shoirah

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Occipital Lobe ◽

Diffusion Restriction ◽

Mri Brain ◽

Artery Of Percheron ◽

Left Posterior ◽

The Family ◽

First Pass

This is an elderly patient who was found unconscious at home. CT of the head without contrast was unremarkable, while CT angiography of the head and neck revealed a subocclusive thrombus on the precommunicating (P1) segment of the left posterior cerebral artery (PCA). MRI brain revealed bilateral regions of diffusion restriction in the paramedian thalami and bilateral medial mesencephalon. Initial angiography confirmed the presence of a subocclusive thrombus in the P1 segment of the left PCA. Thrombectomy was performed achieving recanalisation of the left PCA and reperfusion of bilateral thalami via a visualised artery of Percheron. Postoperatively, the patient was kept on a daily dose of 325 mg of aspirin. The patient did not improve neurologically. A follow-up MRI brain showed diffusion restriction in the left occipital lobe and petechial haemorrhages in the bilateral thalami. The family eventually opted for palliative measures, and the patient expired on day 14 of admission due to acute respiratory failure from palliative extubating.

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