Artery Of Percheron Infarction Research Articles

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.

Holmes Tremor due to Artery of Percheron Infarct: Clinical Case and Treatment Using Deep Brain Stimulation of the Vim and ZI Targets

Holmes Tremor due to Artery of Percheron Infarct: Clinical Case and Treatment Using Deep Brain Stimulation of the Vim and ZI Targets

A rare case with artery of percheron infarction: A mysterious cause of reversible coma

Herein, we illustrated a rare patient with artery of Percheron (AOP) infarction who presented as reversible coma. Through the presentation of this case and literature review, we point out the diagnostic challenges in this entity. Second, we discuss the possible mechanisms of recovery of consciousness in this stroke subtype and remark the need for future reports using advanced functional neuroimaging techniques to clarify the unknown mechanisms underlying the evolution of the clinic in AOP infarction. We believe that the results of these studies may also give crucial insights regarding the processing of some critical functions such as sleep, arousal, and consciousness as well as our understanding of various consciousness disorders.

A case of rare stroke syndrome admitted in intensive care unit - Artery of Percheron infarction

Artery of Percheron is a rare anatomical variant of thalamic vascular supply. Stroke involving this vasculature is an uncommon event. Occlusion of this vessel produces a peculiar pattern in the form of bilateral thalamic infarcts with or without midbrain infarction. This results in variable clinical features ranging from somnolence or altered sensorium to coma in affected individuals, accompanied by characteristic neurological manifestations. Diagnosis of artery of Percheron infarction at the initial presentation may be difficult as it is infrequent and early neuroimaging studies may be negative. Here we report a patient, a case of AOP infarct whose MRI brain and clinical picture demonstrated the characteristic features. Keywords: Artery of Percheron, Ischemic stroke, Thalamus, Magnetic resonance Imaging.

Imaging of Brain Infarctions: Beyond the Usual Territories.

In this review, our intension is to present imaging features of several categories of uncommon cases of brain infarctions including infarctions associated with neurovascular variants, infarctions along small arterial territories, and brainstem stroke syndromes. Infarctions associated with neurovascular variants include azygos anterior cerebral artery territory infarction and artery of Percheron infarction. In the second group, we discuss anterior choroidal artery infarction and artery of Heubner infarction. The third group highlights brainstem stroke syndromes, including Claude and Benedikt syndromes due to midbrain infarction; Foville, Marie Foix, and locked-in syndromes due to pontine infarction; and Dejerine (medial medullary), bilateral medial medullary, and Wallenberg (lateral medullary) syndromes.

Transient coma as Percheron’s artery stroke

The artery of Percheron is a rare anatomic variation in the brain vascularization, in which a single arterial trunk arises from the posterior cerebral artery to supply both sides of brain structures, i.e., the thalamus and midbrain. Occlusion of this uncommon vessel results in a characteristic pattern of bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report the case of a Caucasian woman who completely recovers after transient coma due to Percheron artery infarction.

Artery of Percheron Infarct: A difficult diagnosis in the emergency room. Report of 7 cases in Argentina (P3.3-050)

Artery of Percheron Infarct: A difficult diagnosis in the emergency room. Report of 7 cases in Argentina (P3.3-050)

Artery of Percheron infarct - A missed opportunity of stroke thrombolysis

Artery of Percheron infarct - A missed opportunity of stroke thrombolysis

Poster 293: Artery of Percheron Infarction: A Case Report

PM&RVolume 10, Issue 9S1 p. S97-S97 Poster 293: Artery of Percheron Infarction: A Case Report Firas Y. Rafati DO, Firas Y. Rafati DO Marianjoy Rehabilitation Hospital PM&R P, Orland Park, IL, United StatesSearch for more papers by this authorMarilyn S. Pacheco MD, Marilyn S. Pacheco MDSearch for more papers by this authorDisha R. Patel DO, Disha R. Patel DOSearch for more papers by this author Firas Y. Rafati DO, Firas Y. Rafati DO Marianjoy Rehabilitation Hospital PM&R P, Orland Park, IL, United StatesSearch for more papers by this authorMarilyn S. Pacheco MD, Marilyn S. Pacheco MDSearch for more papers by this authorDisha R. Patel DO, Disha R. Patel DOSearch for more papers by this author First published: 26 September 2018 https://doi.org/10.1016/j.pmrj.2018.08.304Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume10, Issue9S12018 AAPM&R Annual Assembly AbstractsSeptember 2018Pages S97-S97 RelatedInformation

Persistent anterograde amnesia due to the artery of Percheron occlusion: a case report

ABSTRACTBilateral thalamic infarction involving the artery of Percheron (AOP) can cause diagnostic difficulties due to the varying clinical presentations. AOP infarcts presented with isolated memory impairment are not common and the factors affecting the persistence of memory disorders are still unknown. A 41-year-old male patient was hospitalized with acute unconsciousness. MRI disclosed bilateral paramedian thalamic infarction The patient had isolated memory deficit and his anterograde amnesia continued without any change in the past decade. More cases might answer the questions concerning the intra- and extra-thalamic structures responsible for the amnesic syndrome and the factors affecting the persistence of the symptoms.

Artery of percheron infarction: a case report

Artery of percheron infarction: a case report

Status epilepticus as a presenting feature of bilateral paramedian thalamic and midbrain infarct—Artery of percheron infarct?

Abstract Seizures in stroke account for 11% cases of new onset seizure in adults. Risk factors for stroke associated seizures are cortical involvement, anterior hemisphere lesion, cardioembolic etiology. Seizure in case of thalamic or brainstem infarcts have rarely been described in literature and status epilepticus is very rare in these infarcts. Here we report a case of 40 years male patient who presented to emergency room with history of sudden onset vertigo and vomiting, followed by generalised tonic clonic seizures which evolved into status epilepticus. His magnetic resonance imaging of brain with diffusion weighted image (DWI) revealed acute infarct involving bilateral paramedian thalamic and midbrain region. Emergency physician should be aware of this atypical clinical scenario which can facilitate early diagnosis and treatment and thereby improve disease prognosis.

Artery of Percheron Infarct: 12 Cases and Their Complex Clinical Courses.

Strokes involving the artery of Percheron (AOP), an anatomic variant of thalamic vascular supply, are rare. Little is known about the inpatient hospital course for these patients. We retrospectively identified consecutive patients with AOP in their medical charts from a university-based tertiary care hospital from January 1, 2000, to August 15, 2017. A chart review identified demographics, transfer status, in-hospital versus community onset of stroke, emergency medical services (EMS) use, presenting signs/symptoms, time to radiologic diagnosis (from time of presentation to tertiary care hospital or from time of initial symptom onset in an already hospitalized patient), tissue plasminogen activator (tPA) use, intensive care unit (ICU) stays, intubation, length of stay (LOS), and discharge location. After radiologic inclusion/exclusion criteria were applied, 12 patients were included in the study. There were 7 men and 5 women, and the mean age (SD) was 68 (15). Seven were transfers, and 4 had an in-hospital stroke. Of the 8 community-onset strokes, 7 utilized EMS. Mental status changes occurred in 11 of 12 and ocular disturbances in all patients. Time to radiologic diagnosis averaged 1.9 (median = 1.1) days. One patient received tPA. Eight received care in the ICU. Four were intubated. Average LOS was 8.3 days. Four were discharged home, 3 entered inpatient rehabilitation facilities, and 5 entered skilled nursing facilities. In-hospital stroke status further complicates the already challenging diagnosis of AOP infarct, and clinicians must maintain a high suspicion for this rare stroke in order to quickly diagnose and intervene.

Medical image of the week: artery of Percheron infarction

Medical image of the week: artery of Percheron infarction

Sudden Onset Altered Sensorium: Artery of Percheron Infarct

Acute onset Altered mental status is a common but clinically challenging emergency due to numerous possibilities with little clinical window and time to treat. The numerous causes include stroke, encephalitis, organ dysfunction, metabolic, endocrine and intoxication. Amongst the vascular causes, one rare but peculiar cause being artery of percheron infarct. Blood supply to the thalamus and brainstem have various anatomic variations. Artery of Percheron is one such variation in which a single arterial trunk arises from proximal segment of one of the posterior cerebral artery (PCA) and bifurcates to supply bilateral paramedian thalami. Occlusion of this artery, although uncommon results in characteristics pattern of symmetric infarction in bilateral medial thalami with or without mesencephalic infarction. We here describe a case of a gentleman who presented with sudden onset altered mental status and skew deviation. After improvement in sensorium characteristic vertical gaze palsy was noted with subtle confusion which recovered. MRI brain revealed characteristic Para median bithalamic infarcts with normal intracranial angiogram. Patient showed a slow and incomplete clinical recovery to conservative management.