Artery Of Percheron Infarction Research Articles

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.

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

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

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.

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.

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

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.

Prolonged Severe Bradycardia in the Artery of Percheron Infarct.

Prolonged Severe Bradycardia in the Artery of Percheron Infarct.

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 Infarction

Artery of Percheron Infarction

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

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

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.

The Clinical and Cognitive Spectrum of Artery of Percheron Infarction: 1-Year Follow-Up

Survivors of patients with artery of Percheron infarction (API) often have a prolonged and disabling form of cognitive impairment that remains insufficiently characterized. We aimed to examine the clinical and cognitive features of API in the short and long term after stroke. We reviewed 6400 patients with a first-ever stroke included in the Stroke Registry between 2011 and 2021. The diagnosis of API was based on clinical diagnosis and imaging confirmation. All patients underwent neuropsychological assessment at hospital stay and 1 year after stroke. A z-score of each patients' cognitive test point was calculated, and a z-score inferior to 2 was considered as pathological. Of the 10 patients enrolled, all had cognitive impairment, consciousness, and behavioral disorders at stroke onset. Six patients had pure bilateral thalamic involvement while four had bilateral thalamic and rostral midbrain involvement. At 12 months, 50% of patients had global mental state scores 2 SD below the population mean (z-score mean ± SD, -2.17 ± 0.4). Most of the prefrontal cortex cognitive processes including executive functions such as planning and cognitive control (z-score mean ± SD, -3.92 ± 0.3), processing speed (-4.42 ± 0.5), working memory (-3.97 ± 0.3) were severely impaired at stroke onset. Especially in patients with thalamic and rostral midbrain involvement, deficiencies in executive function (z-score mean ± SD, -2.60 ± 0.4), processing speed (-2.22 ± 0.5), working (-3.76 ± 0.4), and episodic memory (-2.23 ± 0.3) continued 12 months after stroke. The occlusion of the artery of Percheron results in severe behavioral and cognitive disorders in the short and long term after stroke.

Association with clinic risk factors of Percheron artery infarction and magnetic resonance imaging involvement patterns.

Radiological imaging is important in the diagnosis of the artery of Percheron (AOP) infarction. This study aimed to discuss the magnetic resonance imaging (MRI) findings of this abnormal variant of arterial supply. Patients who presented to our hospital with stroke symptoms between 2010 and 2019 and underwent brain MRI were evaluated retrospectively. Eleven patients with AOP infarction were included in the study. The mean age of the patients was 67.4 ± 9.6years. Seven (63.6%) of the patients were male and four (36.4%) were female. Accompanying diseases were hypertension in eight patients (72.7%) and coronary artery disease in five (45.4%). In eight patients (72.3%), the infarction of AOP extended under the third ventricle wall, and 90.9% of the patients had an asymmetrical radiographic pattern of ischemic damage. With the widespread use of endovascular stroke treatment, it has become critical to establish a rapid and accurate diagnosis of stroke to achieve recovery without sequela. Therefore, although the infarction of AOP is rare, a rapid and accurate diagnosis is important due to possible morbidity and mortality and can be undertaken using MRI.

Artery of Percheron Infarction: A Characteristic Pattern of Ischemia and Variable Clinical Presentation: A Literature Review.

The Artery of Percheron (AOP) is an uncommon anatomic variant that provides arterial supply to the paramedian region of the thalami and bilaterally to the rostral part of the midbrain; it is a solitary arterial trunk that branches from a proximal segment of the posterior cerebral artery (PCA). Although AOP infarction results in a characteristic pattern of ischemia-namely bilateral paramedian thalamic infarct with or without midbrain involvement-it may cause diagnostic difficulties due to the variety of its clinical presentations and wide differentials, as well as its small diameter and the difficulty of obtaining visualization through diagnostic imaging. Early neuroimaging of AOP infarction and correct diagnosis are mandatory for early initiation of the appropriate treatment and better patient outcomes. In this study, we discuss imaging the patterns of AOP infarction and its differentials and clinical presentation.

A Case of Obtundation Resolved with tPA: Artery of Percheron Infarct (4936)

A Case of Obtundation Resolved with tPA: Artery of Percheron Infarct (4936)

Artery of Percheron infarction with persistent amnesia: a case report of bilateral paramedian thalamic syndrome

BackgroundThe artery of Percheron is an uncommon anatomic variant which supplies the bilateral paramedian thalami and rostral midbrain. While infarction of its vascular territory can result in a wide range of symptoms, paramedian thalamic syndrome is classically described as a triad of symptoms including vertical gaze disturbances, fluctuating level of consciousness, and amnesia. There is minimal evidence to date to characterize the long-term cognitive consequences of infarction of the artery of Percheron utilizing neuropsychological assessment.Case presentationWe describe a 40-year-old female patient initially presenting with dizziness, confusion and falls with unremarkable head CT scans. Subsequent MRI, more than 24 h after symptom onset, identified evidence of bilateral thalamic and rostral midbrain infarction. Neuropsychological testing was administered at 4 months post-stroke, with follow up testing at 1 year. The patient was found to have profound anterograde and retrograde amnesia, which did not change significantly over the first year of rehabilitation, and which was not easily identifiable in everyday encounters due to her relatively intact working memory and social skills.ConclusionsAs early diagnosis of infarction of the artery of Percheron is challenging, patients have frequently missed the time window for acute management of ischemic stroke. Moreover, this case study highlights the need for further research in deciphering the role of the paramedian thalamus in memory and cognition, as well as the importance of standardized neuropsychological testing for the artery of Percheron stroke patients to identify safety and rehabilitation concerns that may be overlooked.

Artery of Percheron infarction presenting as nuclear third nerve palsy and transient loss of consciousness: a case report

BackgroundThalamic blood supply consists of four major vascular territories. Out of them paramedian arteries supply ipsilateral paramedian thalami and occasionally rostral mid brain. Rarely both paramedian arteries arise from a common trunk that arise from P1 segment of one sided posterior cerebral artery (PCA). This is usually due to hypoplastic or absent other P1 and this common trunk is termed Artery of Percheron (AOP). Its prevalence is in the range of 7–11% among the general population and AOP infarcts account in an average of 0.4–0.5% of ischemic strokes. Clinical presentation of AOP infarction is characterized by impaired arousal and memory, language impairment and vertical gaze palsy. It also can present with cerebellar signs, hemi paresis and hemi sensory loss. We herein present a case of AOP infarction presenting as transient loss of consciousness and nuclear third nerve palsy.Case presentationA 51 year old previously healthy male, was brought to us, with a Glasgow coma scale (GCS) of 7/15. GCS improved to 11/15 by the next day, however he had a persisting expressive aphasia. Right sided nuclear third nerve palsy was apparent with the improvement of GCS. He did not have pyramidal or cerebellar signs. Thrombolysis was not offered as the therapeutic window was exceeded by the time of diagnosis. Diagnosis was made using magnetic resonance imaging (MRI) that was done after the initial normal non-contrast computer tomography (NCCT) brain. He was enrolled in stroke rehabilitation. Aspirin and atorvastatin was started for the secondary prevention of stroke. He achieved independency of advanced daily living by 1 month, however could not achieve full recovery to be employed as a taxi driver.ConclusionsBecause of the rarity and varied clinical presentation with altered levels of consciousness, AOP infarcts are easily overlooked as a stroke leading to delayed diagnosis. Timely diagnosis can prevent unnecessary investigations and the patient will be benefitted by early revascularization. As it is seldom reported, case reports remain a valuable source of improving awareness among physicians about this clinical entity.