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NEUROIMAGE
Year : 2020  |  Volume : 68  |  Issue : 5  |  Page : 1265-1266

Teaching Images in Neurology: Artery of Percheron Stroke


1 Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
2 Department of Neurology, Hospital Civil de Guadajara “Fray Antonio Alcalde”, Jalisco, México

Date of Web Publication27-Oct-2020

Correspondence Address:
Dr. German López-Valencia
Departamento de Neurología, Hospital Civil de Guadajara “Fray Antonio Alcalde”, Coronel Calderon 777, El Retiro, 44280 Guadalajara, Jalisco
México
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.294551

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How to cite this article:
Jimenez-Ruiz A, López-Valencia G, Ruiz-Sandoval JL. Teaching Images in Neurology: Artery of Percheron Stroke. Neurol India 2020;68:1265-6

How to cite this URL:
Jimenez-Ruiz A, López-Valencia G, Ruiz-Sandoval JL. Teaching Images in Neurology: Artery of Percheron Stroke. Neurol India [serial online] 2020 [cited 2020 Dec 5];68:1265-6. Available from: https://www.neurologyindia.com/text.asp?2020/68/5/1265/294551




A previously healthy 45-year-old woman presented to the emergency department with an acute history of decreased consciousness. Physical exam was unremarkable except for diminished alertness and difficulty in eye-opening. No focalizing signs were found.

Computed tomography (CT) of the head showed no acute lesions [Figure 1]. Diffusion-weighted magnetic resonance (DWI-MR)/Fluid attenuation inversion recovery imaging (FLAIR) of the brain [Figure 2] and [Figure 3] revealed subacute infarcts of the right paramedian midbrain and bilateral paramedian thalami. A diagnosis of an artery of Percheron ischemic stroke was made.
Figure 1: Computed tomography of the head showing no visible lesions

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Figure 2: Diffusion-weighted magnetic resonance showing a bilateral hyperintense lesion of the thalamus

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Figure 3: Fluid attenuated inversion recovery (FLAIR) sequence showing bilateral rounded thalamic hyperintense lesions

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The artery of Percheron (AOP) is an uncommon vascular variant first described in 1973 by Gerard Percheron. In AOP, a single branch of the posterior cerebral artery supplies irrigation to the thalamus and the midbrain.[1]

AOP occlusion causes bilateral thalamic infarction and is seen in less than 1% of all strokes.[2] This variant is rarely identified on CT or MR angiography due to its small size.[3]

The classic triad is present in more than half of patients and includes vertical gaze palsy (65%), memory impairment (58%), and altered mental status (53%).[4] However, variable involvement of posterior circulation structures may also cause oculomotor palsy, cerebellar ataxia, hemiplegia, and other movement disorders.[3]

The differential diagnosis of bithalamic lesions includes a wide array of ischemic, inflammatory, demyelinating, and neoplasic etiologies.[5]

AOP infarcts prognosis does not differ from that of general ischemic stroke. Early reperfusion strategies are associated with a better functional outcome.[4] Clinicians should be aware of this entity in the setting of acute consciousness impairment.[6]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Percheron G. The anatomy of the arterial supply of the human thalamus and its use for the interpretation of the thalamic vascular pathology. Z Neurol 1973;205:1-13.  Back to cited text no. 1
    
2.
Arauz A, Patiño-Rodríguez HM, Vargas-González JC, Arguelles-Morales N, Silos H, Ruiz-Franco A, et al. Clinical spectrum of artery of Percheron infarct: Clinical-radiological correlations. J Stroke Cerebrovasc Dis 2014;23:1083-8.  Back to cited text no. 2
    
3.
Lazzaro NA, Wright B, Castillo M, Fischbein NJ, Glastonbury CM, Hildenbrand PG, et al. Artery of Percheron infarction: Imaging patterns and clinical spectrum. AJNR Am J Neuroradiol 2010;31:1283-9.  Back to cited text no. 3
    
4.
Cassourret G, Prunet B, Sbardella F, Bordes J, Maurin O, Boret H. Ishemic stroke of the artery of Percheron with normal initial MRI: A case report. Case Rep Med 2010;2010:425734.  Back to cited text no. 4
    
5.
Rodriguez EG, Lee JA. Bilateral thalamic infarcts due to occlusion of the artery of Percheron and discussion of the differential diagnosis of bilateral thalamic lesions. J Radiol Case Rep 2013;7:7-14.  Back to cited text no. 5
    
6.
Aaron S, Mani S, Prabhakar AT, Karthik K, Patil AK, Babu PS, et al. Stuck with a drowsy patient, evoke the Percheron. Neurol India 2015;63:542-7.  Back to cited text no. 6
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