Brain Infarction in the Artery of Percheron Supply Area due to Reversible Cerebral Vasoconstriction Syndrome

Abstract

An ischemic stroke caused by the occlusion of the artery of Percheron encompasses both posterior thalami, and the resulting clinical presentation can mask the clinical presentation of a stroke. We present the case report of a 62-year-old female patient who was admitted to our emergency department in a soporous state after initial headache and dizziness. A neurological exam found left-sided spasticity and a flexor response to pain. Systemic thrombolysis was administered after an urgent computerized tomography (CT) of the brain with angiography. The interventional radiologist proposed a digital subtraction angiography which found a vasospasm in the right medial cerebral artery from the M2 seg- ment reaching distally, and a balloon dilation was done. Following the endovascular procedure, a CT scan showed ischemia in both posterior thalami. Additionally, the patient’s neurological impairment improved at that moment showing Parinaud syndrome, drowsiness, and left-sided palsy. The patient experienced a possible reversible cerebral vasoconstriction syndrome, the cause of which is still unknown, which resulted in an ischemic stroke. The typical clinical presentation of that syndrome was lacking, probably due to the presence of the artery of Percheron ipsilateral to the vasospasm. Our goal in presenting this case study is to draw attention to the artery of Percheron syndrome as a potential clinical sign of an acute ischemic stroke that can easily lead us to be misled.