Abstract
The artery of Percheron (AOP) is a rare anatomical variant of the paramedian thalamic vessels in 7-10% of the general population. An AOP infarct can present with rare clinical manifestations like transient loss of consciousness (LOC) and lethargy, as was seen in the patient whose case is discussed in this report, due to the plethora of regulatory inputs and outputs by the thalamus, which cannot be compensated for because of the absence of anastomotic connections. The AOP supplies the reticular activating system (RAS), which regulates consciousness. Ischemia to this area from an AOP infarct can result in the transient LOC, which our patient experienced. The AOP is a small vessel that is often missed on a CT angiogram (CTA) alone due to low resolution. As a result, it is imperative that clinicians utilize MRI to diagnose AOP infarcts in patients who present with symptoms that raise concerns for decreased bilateral thalamic function and transient LOC.
Highlights
The medial portion of the thalamus and the rostral midbrain are supplied by the artery of Percheron (AOP) in 7-10% of the general population [1]
Obstruction of the AOP can manifest as diverse clinical presentations as a result of the wide range of neurological functions controlled by the thalamus including behavior, cognition, and sensation
Patients with an AOP infarct account for 0.4-0.5% of all ischemic strokes and can present with altered mental status, transient or episodic loss of consciousness (LOC), and memory impairment [2,3,4,5]
Summary
The medial portion of the thalamus and the rostral midbrain are supplied by the artery of Percheron (AOP) in 7-10% of the general population [1]. Increased importance should be placed on identifying AOP infarcts in patients presenting with generalized neurological deficits and lethargy since its occlusion can diminish bilateral function. Variables WBC Hb Platelet count Sodium Potassium Chloride Bicarbonate Creatinine BUN Troponin I He presented to our emergency room two days later with diplopia, left-sided weakness, slurry speech, and lethargy. There were no focal deficits at the time of discharge Given his stroke and no clear etiology, a loop recorder was placed for long-term monitoring of atrial fibrillation. His mental status and left hemiparesis improved, and the patient was discharged home with outpatient physical therapy and occupational therapy. The follow-up on loop recorder at one year did not reveal any atrial fibrillation
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