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|Year : 2020 | Volume
| Issue : 5 | Page : 1265-1266
Teaching Images in Neurology: Artery of Percheron Stroke
Amado Jimenez-Ruiz1, German López-Valencia2, Jose Luis Ruiz-Sandoval2
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 Publication||27-Oct-2020|
Dr. German López-Valencia
Departamento de Neurología, Hospital Civil de Guadajara “Fray Antonio Alcalde”, Coronel Calderon 777, El Retiro, 44280 Guadalajara, Jalisco
Source of Support: None, Conflict of Interest: None
|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
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 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.
AOP occlusion causes bilateral thalamic infarction and is seen in less than 1% of all strokes. This variant is rarely identified on CT or MR angiography due to its small size.
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%). However, variable involvement of posterior circulation structures may also cause oculomotor palsy, cerebellar ataxia, hemiplegia, and other movement disorders.
The differential diagnosis of bithalamic lesions includes a wide array of ischemic, inflammatory, demyelinating, and neoplasic etiologies.
AOP infarcts prognosis does not differ from that of general ischemic stroke. Early reperfusion strategies are associated with a better functional outcome. Clinicians should be aware of this entity in the setting of acute consciousness impairment.
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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]