Bilateral Thalamic Infarction by Percheron Artery Occlusion

Abstract

Objective: The artery of Percheron is an uncommon single trunk variant of the thalamoperforating arteries that supplies the paramedian thalamic territory bilaterally and the rostral midbrain. Four cases of artery of Percheron (PA) occlusion with bilateral paramedian thalamic infarctions are reported, considering aspects of its clinical and radiological presentation, as well its prognosis. Methods: Four patients with infarcts due to PA occlusion were diagnosed. The data for the study were retrospectively obtained from the medical records of patients. Results: Four patients with PA infarctions were diagnosed. All patients have presented a symmetrical bilateral paramedian thalamus infarction, and two of them also presented midbrain involvement, with abnormal images on MRi and CTs. Clinical presentations have included sudden onset of bilateral palpebral ptosis, headache, ophthalmoplegia, aphasia, prostration, confabulation, mental confusion and ataxia. Conclusion: Although rare, occlusion of artery of Percheron should be part of the differential diagnosis when symmetrical bilateral paramedian thalamic and mesencephalic lesions occur