English

Abstract

INTRODUCTON: Bilateral thalamic infarcts are rare presentations of stroke. They are the result of a complex combination of risk factors and a predisposing vessel distribution. An Artery of Percheron is a rare anatomic variation in the brain vascularization seen in one third of population. It was described by French medical scientist Gerard Percheron in 1973. The artery of Percheron, characterized by a single arterial trunk that irrigates both paramedian thalamic regions, can be occluded as a result of thrombo embolic diseases leading to bilateral paramedian thalamic infarcts. The main symptoms are vertical gaze palsy (65%), memory impairment (58%), confusion (53%), and coma (42%). Clinical and image findings of this uncommon form of posterior circulation infarct are presented along with their anatomic and pathophysiologic correlates. CASE PRESENTATION: A 75yrs old right handed female, known diabetic and hypertensive presented with sudden loss of consiousness 6 hrs prior to admission. MRI Brain showed restricted diffusion involving bilateral thalamus and midbrain-Artery of percheron infarct and chronic lacunar infarcts.MR-AngiogramSubacute infarcts in bilateral thalamic region and periaqueductal region of midbrain. The posterior circulation was patent including the tip of the basilar artery and both posterior cerebral arteries, making the case compatible with occlusion of the artery of Percheron. CONCLUSION: Bilateral thalamic infarcts are unusual presentations of posterior circulation stroke. In patients presenting with loss of consciousness, neuropsychiatric involvement bilateral paramedian thalamic infarction, the possibility of artery of percheron infarct should be considered. In addition, periaqueductal grey matter of midbrain can also be involved.