Artery Of Percheron Occlusion Research Articles

Artery of Percheron occlusion: role of diffusion-weighted imaging in the early diagnosis

Artery of Percheron occlusion: role of diffusion-weighted imaging in the early diagnosis

Percheron Artery Occlusion: An Uncommon Cause of Decreased Arousal

Percheron Artery Occlusion: An Uncommon Cause of Decreased Arousal

Differential diagnosis in bilateral thalamic infarct: clinical and radiological aspects

Keywords Top of the basilar syndrome Artery ofpercheron Stroke Bithalamic infarctionA 77-year-old hypertensive man, presented with suddenleft hemiparesis and dysarthria, rapidly progressing to lossof consciousness. He was admitted, with a Glasgow ComaScale (GCS) score of 6/15 and left hemiplegia. A cranialCT showed no acute changes. Brain T2-weighted MagneticResonance Imaging (MRI) showed bilateral signal changesin the medial thalamus and the rostral portion of the mid-brain (Fig. 1).Electrocardiography (ECG), transthoracic echocardi-ography, Holter ECG and a study of the cervical Mag-netic Resonance Angiography (MRA) showed nosignificant abnormalities. A cerebral MRA showed severestenosis at the P1 segment of the right posterior cerebralartery, at the likely emergence of the Artery of Perche-ron (AOP). The basilar and vertebral arteries were patent(Fig. 2). During hospitalization, the patient improvedprogressively. Upon discharge, the patient had mild lefthemiparesis (4/5), dysmetria and dysdiadochokinesia, andinternuclear ophthalmoplegia associated with memoryimpairment.The bilateral thalamic infarct may be found in threeclinical conditions:1. Top of the basilar syndrome: circulatory disturbance atthe top of the basilar artery that involves five arterialbranches: the superior cerebellar arteries, the posteriorcerebral arteries and basilar artery itself between theirjunctions [1].2. Occlusion of the AOP: a single branch of the P1segment of one of the PCA, which also contributes torostral irrigation of the brainstem, in roughly half of allcases [2, 3].3. Deep cerebral venous thrombosis [2–4]: in our case,we can state that it is not this situation. There are nosigns of venous thrombosis from the cerebral MRA;there are no clinical symptoms of thrombosis (head-ache, vomiting, papilloedema and seizure) and thepatient improved without needing anticoagulation (theideal treatment for this pathological condition) [2–4].Conversely, the possibility of the top of the basilarsyndrome or AOP occlusion requires discussion.Regarding the clinical characteristics, both present mentalconfusion, vertical gaze paralysis and memory impairment[2, 3, 5]. Signs and symptoms characteristic of the top ofthe basilar syndrome are: visual field defects, agitatedbehaviour and amnesia, due to involvement of theoccipital and temporal lobes [2]. Some common signs andsymptoms of occlusion of the AOP: oculomotor distur-bances, ataxia, and hemiparesia can also be seen in thetop of the basilar syndrome in the presence of mesence-phalic involvement [1, 5]. Ataxia also can occur in top ofthe basilar syndrome when the superior cerebellar arteryis affected [1, 2]. Just the clinical symptoms, therefore,are insufficient for determining the aetiology in the casedescribed.

Artery of Percheron Infarction as an Unusual Cause of Coma: Three Cases and Literature Review

Stroke due to occlusion of the artery of Percheron (AOP), an uncommon anatomic variant supplying the bilateral medial thalami, may raise diagnostic challenges and cause life-threatening symptoms. Our objective here was to detail the features and outcomes in three patients who required intensive care unit (ICU) admission and to review the relevant literature. Description of three cases and literature review based on a 1973-2013 PubMed search. Three patients were admitted to our ICU with sudden-onset coma and respiratory and cardiovascular dysfunctions requiring endotracheal mechanical ventilation. Focal neurological deficits, ophthalmological signs (abnormal light reflexes and/or ocular motility and/or ptosis), and neuropsychological abnormalities were variably combined. Initial CT scan was normal. Cerebral MRI demonstrated bilateral paramedian thalamic infarction, with extension to the cerebral peduncles in two patients. Consciousness improved rapidly and time to extubation was 1-4 days. All three patients were discharged alive from the hospital and two had good 1-year functional outcomes. Similar clinical features and outcomes were recorded in the 117 patients identified in the literature, of whom ten required ICU admission. Bilateral paramedian thalamic stroke due to AOP occlusion can be life threatening. The early diagnosis relies on MRI with magnetic resonance angiography. Recovery of consciousness is usually rapid and mortality is low, warranting full-code ICU management.

Bilateral Thalamic Infarction by Percheron Artery Occlusion

Objective: The artery of Percheron is an uncommon single trunk variant of the thalamoperforating arteries that supplies the paramedian thalamic territory bilaterally and the rostral midbrain. Four cases of artery of Percheron (PA) occlusion with bilateral paramedian thalamic infarctions are reported, considering aspects of its clinical and radiological presentation, as well its prognosis. Methods: Four patients with infarcts due to PA occlusion were diagnosed. The data for the study were retrospectively obtained from the medical records of patients. Results: Four patients with PA infarctions were diagnosed. All patients have presented a symmetrical bilateral paramedian thalamus infarction, and two of them also presented midbrain involvement, with abnormal images on MRi and CTs. Clinical presentations have included sudden onset of bilateral palpebral ptosis, headache, ophthalmoplegia, aphasia, prostration, confabulation, mental confusion and ataxia. Conclusion: Although rare, occlusion of artery of Percheron should be part of the differential diagnosis when symmetrical bilateral paramedian thalamic and mesencephalic lesions occur

The Artery of Percheron and Etiologies of Bilateral Thalamic Stroke

he artery of Percheron (AOP) is a unique vessel that originates from the posterior cerebral artery (PCA) to supply the T bilateral thalami. Recognition of this anatomic variant should be of practical interest to clinicians, as occlusion of the AOP remains an important cause of bilateral thalamic strokes. The first published report of bilateral thalamic infarctions has been attributed to Beauvois and Lhermitte in 1975 (1). Since then, there has been increasing acknowledgment and association of the AOPwith bilateral thalamic injury. However, this ischemic presentation still remains uncommon. A review of the literature in 2009 identified only 51 cases of AOP involving bilateral thalamic infarcts (17). Similar stroke patterns have also been recognized with other vascular etiologies, such as “top of the basilar” syndrome, as well as cerebral venous thrombosis. Therefore, distinguishing AOP occlusion from other vascular pathologies requires a thorough understanding of the anatomic, clinical, and radiographic differences in order to provide optimal therapeutic management.