Stroke due to Percheron Artery Occlusion: Description of a Consecutive Case Series from Southern Portugal

The artery of Percheron (AOP) is an abnormal variant of the arterial supply of the thalamus. Stroke caused by AOP occlusion is seldom reported. AOP leads to bilateral thalamic and rostral midbrain infarct presenting with unspecific manifestations. There are few descriptions of case series of stroke caused by AOP. We sought to review the clinicoradiological characteristics of AOP infarction from Algarve, Southern Portugal. Eight consecutive cases were retrospectively identified by searching the electronic clinical charts, as well as the stroke Unit database (2015–2020). Sociodemographic (age and gender) and clinicoradiological characteristics (etiological classification, admission severity, manifestations, and short- and long-term prognoses) were retrieved. The corresponding frequency of AOP infarction was 0.17% (95% confidence interval: 0.05–0.28). The mean age was 67.1 (range: 60–80) years. The range of stroke severity evaluated assessed by the National Institute of Health Stroke Scale ranged from 5 to 23 (median = 7.5). None of the patients receive acute ischemic stroke reperfusion treatment. AOP patterns were isolated bilateral paramedian thalamic (n = 2), bilateral paramedian and anterior thalamic (n = 2), and bilateral paramedian thalamic with rostral midbrain (n = 4). Two patients (20%) died on the short term (30 days). At hospital discharge, six patients had functional disability of ≤2 on the modified Rankin scale. In the follow-up at 6 months, half (n = 3) of the survivors had persistent hypersomnia and two had vascular dementia. Stroke from AOP presents with variable clinical and radiological presentations and patients do not receive alteplase. The short-term survivor and the long-term functional independency can be compromised after AOS infarct.

Bilateral thalamic infarction due to artery of Percheron occlusion: a case report

The artery of Percheron is a rare variant of the posterior cerebral circulation. It is characterised by a single arterial trunk that supplies blood to bilateral paramedian thalami and rostral midbrain. Its occlusion can have a very wide range of presentation, and initial imaging including CT of the head maybe normal. Diagnosis and eventual treatment is usually delayed. We describe the case of an elderly man who presented with loss of consciousness, aphasia, and bilateral lower limb weakness. He was diagnosed with bilateral thalamic infarction due to the occlusion of the artery of Percheron only after an MRI of the brain was performed. Despite treatment his symptoms did not resolve completely. Keywords: Thalamus/blood supply, Cerebral arteries, Magnetic Resonance Imaging.

Artery of Percheron Ischaemic Stroke: A Classic Presentation of a Rare Case

The artery of Percheron (AoP) is a rare anatomic variant, where the paramedian thalami and the rostral midbrain are supplied by an artery emerging from the P1 segment of the posterior cerebral artery. Ischaemic infarction of the artery of Percheron occurs rarely, accounting for 0.1 to 2% of all ischaemic strokes. AoP occlusion can lead to an infarction of the paramedian thalami and mesencephalon, resulting in a triad of clinical features; namely, altered mental status, vertical gaze palsy and memory impairment. A larger mesencephalon infarction can also feature oculomotor disturbances. We describe here the case of an 88-year-old patient, presenting with this triad of features.

Artery of Percheron Occlusion: A Diagnostic Challenge

Artery of Percheron occlusion is a rare cause of ischaemic stroke characterized by bilateral thalamus infarction. Presentation is varied and non-specific, with the most frequent manifestations being altered level of consciousness, hypersomnolence or altered oculomotor movements. We describe the case of a 37-year-old man hospitalized for hypersomnia and hypomnesia with 3 days of evolution, who was diagnosed with a bilateral thalamus stroke due to artery of Percheron occlusion.

The “butterfly wings” and midbrain “V” sign of Artery of Percheron infarction

An 80-year-old woman with history of hypertension presented to the emergency department following a fall. Her mental status quickly deteriorated and became obtunded. She was stuporous, and unresponsive to verbal stimuli. She had minimally reactive pupils and was moving extremities to painful stimuli. An MRI scan was performed following an unrevealing CT brain.