Acute bilateral thalamic infarctions with midbrain involvement due to artery of Percheron occlusion

P G N Nadeeshani,T Rajendiran,J Indrakumar,A Liyanage

doi:10.4038/jccp.v51i2.7912

Abstract

The artery of Percheron is a single dominant vessel of posterior cerebral artery which supplies the thalamus bilaterally. It is a rare variant of arterial supply to the paramedian thalami. The classical triad of presentation of artery of Percheron occlusion is vertical gaze palsy, memory impairment, and alteration of mental status. Here we report a case of artery of Percheron occlusion where the patient presents with classic features of thalamic infarction associated with the midbrain involvement evidenced by the presence of bilateral hemiparesis. When compared to the typical thalamic infarction alone, the prognosis is worse when midbrain is also affected.

Highlights

The artery of Percheron is an uncommon anatomical variant of arterial supply to the paramedian thalamus and rostral midbrain
There is a wide variability of arterial supply among individuals (Figure 2)
The artery of Percheron is a part of the posterior cerebral circulation characterized by a solitary artery that supplies blood to the bilateral paramedian thalami and the rostral midbrain.[2,3]

Summary

Introduction

The artery of Percheron is an uncommon anatomical variant of arterial supply to the paramedian thalamus and rostral midbrain. A 54-year-old woman, with a history of diabetes taking metformin and gliclazide, was admitted with sudden onset of reduced responsiveness She was in good health until two days before when she had developed diarrhea and vomiting. On admission to the hospital, she was deeply somnolent Her blood pressure was 130/80mmHg, pulse rate was 80 bpm, and oxygen saturation was 100%. The right-side pupil was dilated with impaired light reflexes Examination of both upper and lower limbs showed bilateral asymmetrical (right>left and upper limb > lower limb) weakness. Received 18 Febuary 2020, accepted 20 May 2020 She was discharged from the hospital and followed up at medical clinic

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Conclusion