Artery Of Percheron Research Articles

Intravenous thrombolytic therapy for cerebral infarction due to the Persheron artery occlusion. Case report

Occlusion of the artery of Percheron is the cause of bilateral thalamic infarctions, sometimes involving structures of the midbrain. A clinical case of intravenous thrombolytic therapy for ischemic stroke due to the occlusion of the Percheron artery in a 72-year-old female patient who developed depression of consciousness, oculomotor disorders, dysarthria, ataxia, pyramidal disorders, and cognitive disorders is presented. Magnetic resonance imaging, which detected bilateral thalamus paramedian infarction in the acute stage, made it possible to diagnose the occlusion of the Percheron artery. Intravenous thrombolysis led to a rapid regression of symptoms; at the end of the acute period of the disease, the patient was discharged from the hospital with a slight neurological deficit and with a good functional outcome. After a one year the dynamic observation revealed persistent mild cognitive disorders; magnetic resonance imaging showed small symmetric cystic-gliosis changes in the medial parts of the thalamus on both sides. Timely diagnosis and intravenous thrombolytic therapy contribute to a good outcome of cerebral infarction due to the Percheron's artery occlusion.

Infarction Due to Occlusion of Artery of Percheron.

Infarction Due to Occlusion of Artery of Percheron.

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.

Bilateral thalamic lesions: a pictorial essay

The aim of this pictorial review is to familiarize radiologists with the numerous pathologies that can affect bilateral thalami while demonstrating their several neuroimaging manifestations. Vascular etiologies include infarcts of the artery of Percheron, tip of the basilar syndrome, venous infarcts, hypoxic-ischemic encephalopathy, PRES, hypertensive microbleeds, and CADASIL; infectious etiologies include Creutzfeldt-Jakobs disease and encephalitides, while demyelinating disorders include ADEM and MS. Bilateral thalamic involvement may also be seen in metabolic & toxic etiologies such as Wernicke encephalopathy, osmotic myelinolysis, Fabry disease, Fahr disease, Wilson disease, and Leigh disease. Furthermore, low- and high-grade gliomas may originate or infiltrate bilateral thalami while gadolinium deposition can be a mimicker of disease. Radiological features that can be used in the assessment and differential approach include MR signal characteristics, calcifications, exact location within the thalamus, symmetry, presence of synchronous extra-thalamic involvement, and presence of expansion. Additional imaging tools such as DWI, MRA/MRV/CTA/CTV, MRS, PWI, and correlation with clinical and laboratory findings may narrow the differential diagnosis.

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.

Focusing on single CT perfusion quantitative maps: Percheron's artery stroke detection in an emergency setting

Occlusion of Percheron Artery may be challenging due to its rare occurrence, confounding clinical presentation and neuroimaging assessment.

101 MRI Brain Solutions, 1st Edition: A Book Review

This book is written by a group of Neuroradiologists from an Indian university and published by Jaypee Brothers Medical Publishers (P) Ltd see (Figure 1). The first chapter discusses the physical principles of MRI and the 2nd chapter illustrates brain anatomy. From the 3rd to 11th chapter, all chapters discuss different malformations and disorders that affect the brain. Chapters 12th and 13th are glossary and acronyms respectively. The only colored pictures are in the plate and the rest of the book illustrations has no colors. Each chapter is written by a Neuroradiologists of the 14 authors of the book (3 editors and 11 contributors). The used method in 3rd to 11th chapter is a presentation of a case as an example of the brain malformation or disorder on an MRI scan. The book uses Radioland’s style in presenting the cases. Each case will have a case presentation and history, MRI scan pictures, MRI findings, comments and explanations, opinions, and clinical discussion. This book is (101), so it is for beginners and it does not cover all MRI neuroradiology topics since it has 101 cases only. The book has too many English language mistakes and a significant lack of proofreading. Some of the MRI images have poor image quality. The book is printed on high-quality papers. In some chapters of the book, there are some CT scans to show the difference between MRI and CT in the ability to show some of the abnormalities. The medical illustration is not high-quality illustration; for example; the Percheron artery was illustrated in the book poorly. Nobody should expect to see professional illustrations like Netter’s style in illustrations in this book. In the book, they rarely use arrows to indicate the location of the pathology. The book does not mention some of the famous neuroradiology signs. In the subdural hematoma case, they present a case of acute on chronic hematoma as subdural hematoma case which would be better to show acute in one case, chronic in one case, and acute on chronic on a third case because this book is for beginners. Some anatomical illustrations are out of the chapter which discuss the anatomy of the brain like the illustration of the cerebral venous system on page 137, figure 28. From page 139 to 144, the book presents three anatomical variations in the brain’s vasculatures (carotid cavernous fistula, persistent occipital sinus, and fetal posterior cerebellar artery) which would be better to be in a separate chapter about anatomical variations. Sometimes, the book will mention a famous neuroradiology sign without providing any MRI image as a demonstration. As well, the book will describe some findings which is invisible on MRI images and the authors will write “not seen in these images”. If the finding is not demonstrated for the readers, the authors should not mention it in the findings. Instead, they can include this undemonstrated finding in the comments and explanation section of the case. This book will mention too many things (radiological signs, findings, associated conditions, etc.) without showing figures for what they are writing about like in the astrocytoma case they mention astrocytoma’s types without differentiating them on figures. Plus, the cases are not mentioned in an organized fashion. For example, the book will speak about a tumor that affects a specific region (let’s call it region number 1) then they will write about another tumor in a different region (let’s call it region number 2) then they jump back to the first region and write about another tumor that affects region number 1. The book needs to be organized to write; for example; the tumors in cerebellopontine angle together which will help the reader to collect and compare all the information about the tumors that affect this region then move to another region. The book will provide a low image quality with too many artifacts; for example; the diffusion image in the hypoglycemia case. The artifacts chapter discusses only three common types of artifacts which are the Gibbs phenomenon, zipper artifact, and susceptibility artifact. The chapter can be improved by organizing the artifacts like; patient-related, signal processing related, and machinery (hardware) related artifacts. The artifacts’ chapter is placed in between clinical cases which should be removed to the beginning or at the end of the book. The last chapter collected different cases under miscellaneous.

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.

Topographic evaluation of bithalamic infarcts: Are these due to occlusion of the artery of Percheron?

Occlusion of the artery of Percheron (AoP) causes bithalamic paramedian infarct (BTPI). Although it can be diagnosed easily in its pure form, it can be underdiagnosed in cases with concomitant extrathalamic acute infarcts (plus-BTPI) as it may be difficult to determine whether BTPI is due to occlusion of AoP or two different paramedian arteries even with conventional angiography. This study was performed to highlight plus-BTPI that could result from occlusion of AoP rather than of two distinct paramedian arteries using topographic evaluation of bithalamic infarcts. We retrospectively reviewed imaging and clinical databases for patients admitted to radiology department between 2013 and 2019. Two radiologists independently evaluated the results of imaging studies, and findings reached by consensus were used in the analysis. This retrospective review yielded 34 patients with bithalamic infarct. Each affected thalamic vascular region was investigated separately. Any patient could have more than 2 different vascular zone infarct. The affected thalamic vascular territories were paramedian (n = 24), inferolateral (n = 13), anterior (n = 10), and posterior (n = 7). When we evaluated bithalamic infarcts in terms of symmetrically affected territories, the distribution of symmetric affected territories was as: paramedian (n = 18), inferolateral (n = 2), anterior (n = 1), and posterior (n = 1). BTPI had a 4.5-fold higher frequency than the sum of symmetric involvement of other territories (p = 0.0552, OR = 4.5,95%CI 0.93–21.5). In addition, mesencephalic involvement was only observed in BTPI, and not in other patterns (p < 0.001).The fact that in bilateral thalamic infarcts the symmetric involvement of paramedic territory is significantly higher and mesencephalic involvement is seen only in BTPI can suggest that plus-BPTI may develop due to AoP occlusion rather than occlusion of two distinct paramedian arteries.

Percheron’s Occlusion: Difficulty of Clinical Diagnosis about One Case in the Teaching Hospital of Cocody (Abidjan-RCI)

Ischemic strokes have varying etiologies and multiple locations. Some locations are much rarer than others and just as difficult to diagnose. This is the case of the ischemic bi-thalamic stroke, attributable to the Percheron artery occlusion that we report in a 33-year-old woman with a history of taking estrogen-progestin. The lesion diagnosis could only be possible thanks to the performance of brain MRI, thus testifying to the diagnostic difficulties observed. Etiological research has shown dyslipidemia. The length of stay was 88 days. At the end of intensive care, the patient was conscious, not deficient and did not present memory disorders.

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.

Thrombolyse intraveineuse dans l’infarctus cérébral du territoire de l’artère de Percheron

The artery of Percheron (AP) or type IIb is an anatomical variant corresponding to a unique arterial trunk that vascularises both the thalami and the midbrain. Occlusion of the AP, although rare, causes bithalamic infarcts characterised by acute polymorphic neurological symptoms, which are often dangerous and include coma necessitating resuscitation. Magnetic resonance imaging (MRI) diffusion weighted imaging (DWI) allows a quick positive diagnosis. Intravenous thrombolysis (IVT), if administered, helps to improve the neurological prognosis.

Sudden loss of consciousness due to artery of Percheron infarction

Acute cerebral infarction due to occlusion of the artery of Percheron (AOP) is rare and poses a diagnostic challenge due to unspecific clinical symptoms. A prompt diagnosis and treatment is vital due to a potentially very serious outcome. Here we represent a healthy young woman who developed sudden headache and loss of consciousness. At admission she was unconscious with GCS of 4, pupils were unevenly dilated and poorly reactive and the plantar reflex was upward bilaterally. She had seizure like movements in all limbs. CT of brain and CT angiography were normal but acute MRI showed bilateral paramedian thalamic diffusion restriction. The patient was treated with i.v. thrombolysis (tPA) 70 minutes after hospital arrival and recovered fully.

Bilateral thalamic infarction secondary to artery of Percheron occlusion: A rare cause of acute coma

An occlusion of the artery of Percheron (AOP) is a rare clinical condition that remains a diagnostic challenge for physicians given its variable presentation. This infarction is a result of an anatomical variant of a single vessel arising from the posterior cerebral artery. Occlusion of the AOP results in variable levels of alteration of consciousness, vertical gaze palsy, and memory impairment. Unfortunately, due to this variable presentation these strokes are often missed. We report a case of a 71 year-old-female who presented with sudden onset of unresponsiveness who was subsequently diagnosed with bilateral thalamic infarction with midbrain involvement secondary to AOP occlusion. Delayed diagnosis can result in poor neurologic outcomes as demonstrated in this case making it imperative to bring further awareness to this clinical syndrome.

POSTERIOR CIRCULATION ISCHAEMIC STROKE IMAGING – CORRELATES AND PERSPECTIVES

Posterior circulation ischaemic stroke (PCIS) is a disease of high mortality and morbidity. However, current research predominantly focuses on the anterior circulation, specifically the internal carotid artery. Recommendations of change are required for the improvement of clinical outcomes. This article discusses the neuroimaging techniques used for diagnosis and three new research perspectives in neuroradiology concerning PCIS, which are namely (1) clinically significant anatomical variants, (2) artery-artery embolisation and, (3) collateralisation. The anatomical variants discussed include: (a) vertebral artery hypoplasia/agenesis, (b) Artery of Percheron, and (c) vertebrobasilar dolichoectasia. Such research perspectives are expected to increase clinical awareness and diagnostic accuracy, ensuring prompt treatment, improved patient care and ameliorated treatment outcomes. This article also suggests that, in the field of collateralisation in PCIS, prognostication can be improved by the construction of risk stratification models and synthesis of new therapeutic strategies.

A Patient with a Delayed Diagnosis of Artery of Percheron Occlusion in Whom Thrombectomy Was Effective.

A case of posterior cerebral artery (P1 segment) occlusion with consciousness disturbance and Weber's syndrome treated by mechanical thrombectomy is reported. The patient was a 69-year-old man with consciousness disturbance, left hemiparesis, and anisocoria. MRI revealed acute cerebral infarction in the midbrain and right thalamus. Angiography demonstrated that the right P1 segment was occluded and mechanical thrombectomy was performed. The right P1 segment and its perforator artery, the artery of Percheron (AOP), were both recanalized after the treatment, and the symptoms of perforator occlusion significantly improved. Mechanical thrombectomy for P1 segment occlusion may be effective for improving the symptoms caused by occlusion of its perforator, the AOP.

Acute bilateral thalamic infarctions with midbrain involvement due to artery of Percheron occlusion

The artery of Percheron is a single dominant vessel of posterior cerebral artery which supplies the thalamus bilaterally. It is a rare variant of arterial supply to the paramedian thalami. The classical triad of presentation of artery of Percheron occlusion is vertical gaze palsy, memory impairment, and alteration of mental status. Here we report a case of artery of Percheron occlusion where the patient presents with classic features of thalamic infarction associated with the midbrain involvement evidenced by the presence of bilateral hemiparesis. When compared to the typical thalamic infarction alone, the prognosis is worse when midbrain is also affected.

Acute vascular dementia with bi‐thalamic infarction due to the artery of Percheron occlusion

AbstractBackgroundPrevious studies reported the altered mental status and behavioral amnesic impairment were the dominated clinical findings in patients with bi‐thalamic paramedian infarction only due to the occlusion of the artery of Percheron(AOP). However, the clinical features of multidomain cognitive impairment because of bi‐thalamic paramedian infarction need to be clarified.MethodWe report a 72 year old male with a history of hypertension who presented an acute vascular dementia with a multidomain cognitive impairment including memory, attention, orientation. Laboratory test results were not remarkable. Brain magnetic resonance imaging (MRI) revealed a bi‐thalamic symmetrical paramedian infarction. Large arterial computed tomography angiography (CTA) showed the thinner right vertebrobasilar artery and atherosclerotic plaques in the beginning of both internal carotid arteries and the right subclavain artery. Transthoratic echocardiograp‐ ‐hy revealed left ventricular diaslolic dysfunction with ejection fraction of 60%. 24‐hour dynamic eletrocardiogram(Holter) revealed paroxymol atrial tachycardia. However, there was no evidence of cardioembolism.ResultThe diagnosis of cerebral infarction that causes vascular dementia with a presumed occlusion of the artery of Percheron resulting from atherosclerosis was made and the treatment of antiplatelate and improving cognition was provided.ConclusionThis case illustrates vascular dementia resulting from bi‐thalamic paramedian infarction deserves clinical attention.

The time course of acute Percheron artery ischemic coma on imaging: A retrospective cohort study

We were to investigate the time course of lesions for awakening in acute Percheron artery ischemic coma (PAIC), which was previously unknown. Patients who had newly identified acute PAIC events in 2012–2015 and had not received thrombolytic therapy were enrolled retrospectively. The time course of lesions in PAIC was investigated by diffusion-weighted imaging (DWI). Ninety-three patients met the inclusion criteria, of whom 63 and 30 had transient PAIC and persistent PAIC, respectively. The time course of awakening events in persistent PAIC decreased over time, with large lesions in the bilateral paramedian thalamus/ rostral midbrain on DWI almost in all patients who was either plus or minus a “top of basilar artery” strokes. Whereas awakening events in transient PAIC increased over time, with small or lacunar lesions in the unilateral or bilateral thalamus/rostral midbrain about in 30.2 % cases, and the rest in naturally recanalization of infarcts or TIA. Lesion volumes were larger for persistent PAIC than for transient PAIC (median, 2.4 cm3 vs. 0.03 cm3, P < 0.0001). In Cox hazards ratio (HR) analysis, a lower GCS score was associated with mortality (HR, 5.5; 95 % confidence interval [CI],1.427–21.45). Multivaliate analysis shown that the predictors of higher risk of persistent PAIC were only increased NIHSS scores (HR,1.3; 95 % CI,1.109–1.640) and large lesions in bilateral thalamus/rostral midbrain (HR,15.0; 95 % CI,1.440–58.13). The time course of acute PAIC included transient and persistent. Most persistent PAIC was associated with large lesions in bilateral paramedian thalamus/ rostral midbrain, and with high mortality.