Artery Of Percheron Infarction Research Articles

Vertical one-and-a-half syndrome in artery of Percheron infarct

Vertical one-and-a-half syndrome in artery of Percheron infarct

Coma Due to Artery of Percheron Infarction: An Unusual Case Report

Ischemic stroke attributable to obstruction of the artery of Percheron (AOP), an infrequent anatomical arterial variant perfusing both medial thalami, can pose difficult diagnostic challenges. Obstruction or occlusion of the AOP results in bilateral paramedian thalamic infarction which is an unusual and rare vascular cause of coma. We present a 65-year-old male patient who came to the emergency department with altered sensorium for 10 days. The initial computed tomography (CT) brain was normal, followed by subsequent CT revealing an ill-defined hypodensity in the ventromedial aspect of the left thalamus and ventral aspect of the midbrain. T2/fluid-attenuated inversion recovery magnetic resonance imaging illustrated hyperintensity in the mesencephalon and bilateral paramedian thalami with restricted diffusion, suggesting an AOP infarct.

Artery of Percheron infarct – An ophthalmologist’s perspective

Thalamus is an important relay station in diencephalon which receives its blood supply mostly from the posterior cerebral artery. The Artery of Percheron (AOP) arises from the posterior cerebral artery and bifurcates to supply paramedian thalami. AOP infarction, though rare, presents with a triad of clinical features including altered mental status, memory impairment, and supranuclear vertical gaze palsy. Our patient had concurrent manifestation of vertical gaze palsy (both upward and downward) and third cranial nerve palsy in the left eye, which is an interesting clinical amalgamation. Our case report elucidates the quick recognition of the abnormalities in ocular motility through a simple, yet effective nine gaze ocular motility evaluation and thereby enhancing clinical recognition of this entity among the practicing general Ophthalmologists.

Successful Thrombolysis in Artery of Percheron Infarction: Grabbed an Extremely Rare Opportunity

Artery of Percheron (AOP) is an uncommon anatomical variation in the posterior circulation neurovasculature. It is a single artery arising from P1 segment of posterior cerebral artery (PCA) which supplies bilateral paramedian thalami and the rostral midbrain and as a result, occlusion of it leads to bilateral thalamic and mesencephalic infarction. Due to very low incidence (ranges from 0.1% to 2% of all ischemic strokes) and varied presentation, the diagnosis of AOP infarction requires strong clinical and radiological suspicion and hence, AOP infarction is often missed and patients are rarely thrombolysed. Here we discuss a patient with acute altered sensorium who recovered completely in short time following treatment with intra-venous thrombolysis for bilateral medial thalamic ischemic stroke due to AOP occlusion.

Isolated Hypersomnia Due to Bilateral Thalamic Infarcts: A Case Report

Thalamic pathology should be considered in patients with vague nonlateralizing neurological symptoms. Diagnosis of Percheron artery infarction is challenging and ofen made later in presentation due to lack of clinical awareness and the nonclassic stroke signs/symptoms on presentation. In this article, we report a case of bilateral thalamic stroke whose clinical presentation was dominated by a sudden onset of hypersomnia.

Artery of Percheron Infarction: Clinical Presentation and Outcomes.

Occlusion of the artery of Percheron (AOP) produces bilateral thalamic infarction classically leading to deficits of arousal. This nonspecific presentation complicates the diagnosis of acute ischemic stroke. We sought to describe the spectrum of clinical presentation, diagnostic neuroimaging findings, and outcomes in AOP infarction (AOPi). We conducted a keyword search of our health system's neuroimaging database from 2014 to 2022 to identify patients with AOPi. We abstracted patient demographics, clinical presentation, neuroimaging findings, acute treatment, and modified Rankin Scale (mRS) scores (at baseline, 3 months, and 12 months). We used descriptive statistics to report our findings. Our initial keyword search identified 192 potential AOPi cases. Fifteen cases of AOPi were confirmed and included in our study (8 female [53%], median age 65 years [interquartile range (IQR): 59.5-79.5], median presenting NIHSS 6 [IQR: 2-22]). Common clinical findings on presentation were systolic blood pressure (SBP) > 140: 12 patients (80%); decreased level of consciousness (LOC): 11 patients (73%); diplopia: 8 patients (57%); disorientation: 6 patients (42%); dysarthria: 4 patients (28%); and acute memory/cognitive disturbance: 3 patients (21%). Twelve cases (80%) presented to the emergency department (ED). Median time from symptom onset to ED arrival was 774.5 minutes (IQR: 202.25-3789.0), 4 cases (27%) arrived within 4.5 hours, and one patient (7%) received intravenous thrombolysis. The median time from ED arrival to stroke diagnosis was 519.0 minutes (IQR: 227.5-1307). Head CT was only diagnostic when obtained >570 minutes from time last known well; MRI was diagnostic at all time points. Rates of functional independence (mRS ≤2) at baseline, 3 months, and 12 months were 64%, 21%, and 18%, respectively. The diagnosis of stroke was considerably delayed in patients with AOPi, and only one patient received IV thrombolysis. SBP >140, impaired consciousness, and diplopia were the most common findings at presentation. CT was often nondiagnostic, but MRI demonstrated bilateral thalamic infarct in all cases. AOPi caused considerable long-term morbidity. Clinicians should maintain a high degree of suspicion for AOP stroke and consider thrombolysis in appropriately selected patients.

Acute Infarction in the Artery of Percheron Territory During Cerebral Angiography: A Case Report

We present a case of a 51-year-old man with a history of hypertension and diabetes who underwent cerebral angiography for evaluation of spontaneous subarachnoid hemorrhage. The procedure was unremarkable, but the patient did not wake up and remained minimally responsive afterward. Imaging studies showed bilateral medial thalamic and midbrain infarctions consistent with an artery of Percheron infarction. The patient received antiplatelet therapy and had minimal improvement in his cognitive function. He was discharged to a rehab center after one week of hospitalization. We shortly discuss this rare complication including the risk factor, clinical presentation, and the management.

When a Hypersomnolent Hemodialyzed Patient Actually Has a Rare Stroke: A Case of Artery of Percheron Infarction With Paradoxical Embolism.

Artery of Percheron (AOP) is an uncommon anatomic variant of the arterial supply of the medial thalami. Owing to variable clinical presentation, challenging imaging diagnosis, and its rarity, it is difficult to diagnose AOP infarctions. We present a clinical case of a unique presentation of AOP infarction associated with paradoxical embolism and highlight the atypical clinical manifestations and challenging diagnosis of this stroke syndrome. A 58-year-old White female with chronic renal insufficiency on hemodialysis was admitted to our center with a 10-hour course of hypersomnolence and right-sided ataxia. She had normal body temperature, blood pressure, peripheral oxygen saturation, and heart rate and scored 11 points in the Glasgow Coma Scale and 12 points in National Institutes of Health Stroke Scale. Initial brain computerized tomography scan, electrocardiogram, and thoracic radiography were normal; transcranial Doppler ultrasound showed >50% stenosis at the P2 segment of the right posterior cerebral artery, and transthoracic echocardiogram, a patent foramen ovale and thrombus adherent to the hemodialysis catheter. On day 3, she underwent brain magnetic resonance that showed acute ischemic lesions at the paramedian thalami and the superior cerebral peduncles. AOP infarction due to a paradoxical embolism from a patent foramen ovale with a right atrial thrombus was the final diagnosis. AOP infarctions are a rare type of stroke with elusive clinical presentations and frequently, initial imaging assessment is normal. Early recognition is crucial, and a high index of suspicion is needed to suspect this diagnosis.

Artery of Percheron infarct - classical imaging findings in two cases.

Artery of Percheron infarct - classical imaging findings in two cases.

Diffusion Restriction in Bilateral Thalami: Beyond Artery of Percheron Infarct.

Bilateral thalamic infarction, especially the medial thalamus, has been characteristically described in the artery of Percheron (AOP) affection. However, bilateral thalamic restriction has been described in many entities beyond the AOP infarction. Here we describe a case series (three cases) with infection as an etiology for bilateral thalamic lesions in the topographic distribution of the AOP from a tertiary care center in tropical India. : Case series during a 1-year period collecting cases with bilateral thalamic diffusion restriction on MRI who did not have thalamic infarcts and their outcomes. : Bilateral thalamic lesion can occur in both bacterial and viral infections such as tuberculosis, dengue, and SARS-COV-2. Thus, we intend to add infections as one of the etiologies in the ever-expanding list of conditions that produce bilateral thalamic restriction. All the acute symmetric thalamic lesions are not always secondary to vascular insult. Accurate assessment and prompt diagnosis can prevent unnecessary delays in treatment. To our knowledge, this is the first case series in the literature that throws light on the bilateral thalamic lesions in the topographic distribution of the AOP secondary to infections in a tropical country like India.

Artery of Percheron Infarction: Clinical Presentation and Outcomes (P6-5.032)

<h3>Objective:</h3> We sought to characterize the presentation, acute treatment, and outcomes in patients with artery of Percheron (AOP) strokes. <h3>Background:</h3> The AOP is an uncommon vascular variant whose occlusion produces bilateral thalamic infarction often resulting in deficits of arousal. <h3>Design/Methods:</h3> We conducted a keyword search of our institution’s neuroimaging database from 2014–2022. All possible cases of AOP infarction were reviewed by two neurologists. We abstracted patient demographics, clinical presentation, acute treatment, acute neuroimaging findings, and laboratory results from the medical record. The median modified Ranking Scale (mRS) and interquartile range (IQR) at baseline, 3 months, and 12 months was analyzed to assess post-AOP stroke disability. Descriptive statistics were used to report clinical findings. <h3>Results:</h3> Our initial search identified 192 potential AOP cases. Fourteen cases of AOP infarction were confirmed and included in our study (8 female [57.1%], median age 67.5 [IQR 60.75–75], median presenting NIHSS 6 [IQR 2–15.25]). Hypertension or systolic blood pressure &gt; 140 (78.5%), decreased level of consciousness (6, 42.8%), and diplopia (6, 42.8%) were the most common presenting complaints. Eleven cases (78.6%) presented to the emergency department (ED). Median time from symptom onset to ED arrival was 14.3 hours (IQR 3.4–63.1); four cases (28.6%) arrived within the conventional thrombolysis time window. Median time from ED arrival to stroke diagnosis was 4.6 hours (IQR 3.8–15.8). Only one patient (7.1%) received IV thrombolysis. Median mRS increased from 2.0 (IQR 0–4) at baseline to 4.0 (IQR 3–5) at 3 months, and 4.0 (IQR 3–4.5) at 12 months. <h3>Conclusions:</h3> Apart from diplopia and hypertension, AOP infarction patients had diverse, non-specific clinical presentations resulting in delayed diagnosis. As a result, despite AOP infarction causing considerable long-term disability, only one patient received IV thrombolysis. Clinicians should maintain a high degree of suspicion for AOP stroke and intervene aggressively in appropriately selected patients. <b>Disclosure:</b> Dr. Ramezani Hashtjin has nothing to disclose. Dr. Ikramuddin has nothing to disclose. Dr. Streib has nothing to disclose.

Prolonged Severe Bradycardia in the Artery of Percheron Infarct.

Prolonged Severe Bradycardia in the Artery of Percheron Infarct.

Prevalence, clinical features, and radiological pattern of artery of Percheron infarction: a challenging diagnosis.

Occlusion of artery of Percheron (AOP), a rare variant of paramedian branches of posterior cerebral artery, results in a characteristic pattern of ischemic lesions in bilateral paramedian thalami with or without midbrain and anterior thalami involvement. To evaluate the prevalence, the clinical, and the imaging features of AOP infarction in a single comprehensive stroke center experience. We retrospectively search in our stroke center database, patients with ischemic lesions in the AOP distribution. We collected clinical features and time between hospital admission and diagnosis. Imaging findings were categorized following a pre-selected classification. Of 2830 ischemic stroke admitted in our center, we identified 15 patients with AOP infarction (0.53%). Clinical manifestations were variable, but oculomotor disturbances, particularly vertical gaze palsy, were the most observed, followed by consciousness impairment, varying from drowsiness to coma. The most frequent imaging pattern was bilateral paramedian thalamic infarction with midbrain infarction, and the V-sign was recognized in 6 cases from this group. In 8 patients a fetal origin of the PCA was observed. The average time from first hospital admission to diagnosis was 28.09h. The prevalence of AOP infarction in our center was 0.53%. Diagnosis of AOP infarction can be challenging and should be suspected in case of sudden altered consciousness.

A rare variant of thalamic stroke- artery of Percheron infarct

The thalamus is a walnut-sized structure that is located in the brain which receives rich blood supply from posterior cerebral artery and its communicating branches. One of the unusual presentations is the infarction of artery of percheron. Hereby reporting a case of 68-year-old female with no known co-morbidities who presented to the emergency department with complaints of sudden onset loss of consciousness in the morning. On further investigation, was found to have infarction of one of the variants of thalamic perforating arteries.

Artery of Percheron Infarct: A Case Series

Artery of Percheron Infarct: A Case Series

A clinical study of artery of Percheron infarction

Artery of Percheron (AOP) infarction, a rare cause of acute altered mental status (AMS), is characterized by bilateral paramedian thalamic infarction. The aim of this study was to review the clinical manifestation, radiological patterns, treatment, and prognosis of patients with AOP infarction. This retrospective case series included patients with AOP infarction from 2009 to 2020 from a medical center in Taiwan. We defined AOP infarction as acute bilateral paramedian thalamic infarction from magnetic resonance imaging, and patients were further categorized by their additional AOP territorial involvements. We determined outcomes with the modified Rankin Scale at discharge. Among the 10 included patients, AMS was the most common presentation (90%). We identified two patients with bilateral vertebral artery (VA), five with unilateral posterior cerebral artery (PCA), and one with bilateral PCA occlusion. Atherosclerosis was the most common presumed etiology (60%). Two and eight patients had favorable and unfavorable prognoses, respectively. PCA occlusion, rather than VA and BA occlusion, was common in angiography. Residual symptoms often resulted in significant disability at discharge. Basilar tip syndrome may share indistinguishable thalamic infarct patterns with AOP infarction but could be differentiated by angiography and other infarcted territories.

"Artery of Percheron Infarct - An Unusual Complication of Tuberculous Meningitis".

"Artery of Percheron Infarct - An Unusual Complication of Tuberculous Meningitis".

Artery of Percheron Infarction

Artery of Percheron Infarction

Artery of Percheron Infarction, a Rare Presentation; a Case Report

Posterior fossa strokes, namely “Strokes in the territory of the posterior cerebral artery,” remain a challenging diagnosis. Its variable stuttering symptoms and non-focal manifestations result in a delay of its diagnosis and poor outcome. Artery of Percheron (AOP) is an anatomical vasculature variant arising from the P1 segment of a Posterior Cerebral Artery (PCA) as a single dominant thalamic perforating artery that supplies bilateral paramedian thalami and the rostral mesencephalon. Bilateral thalamic infarcts can present with altered mental status, hypersomnolence up to coma, aphasia, memory impairment, and vertical gaze palsy. Given the lack of classic stroke signs, the majority of AOP infarcts are not diagnosed in the emergency setting. Diagnosis is usually made following an MRI brain scan, which is usually obtained outside the therapeutic window for IV tissue plasminogen activator (tPA) administration. Timely vessel imaging is critical for diagnosis and initiation of treatment in those patients. This case highlights the rare presentation and diagnostic difficulty of a patient with an AOP infarction and reminds us to include thalamic pathology in patients presenting with nonspecific neurological symptoms and no obvious signs of stroke.

A case series: Artery of Percheron syndrome

Thalamus and midbrain share a complex blood supply from perforators arising from posterior cerebral artery (PCA) and posterior communicating artery. Artery of Percheron (AOP) is a rare anatomic variant arising from a PCA supplying paramedian thalami bilaterally and rostral midbrain. Occlusion of AOP infarcts with characteristic symptoms of vertical gaze palsy, memory impairment and coma called AOP Syndrome. It accounts for 0.3% of ischemic strokes. We share experience of managing four case of AOP strokes.