Artery of Percheron infarction: a case report

Abstract

Background: The artery of Percheron is a rare anatomic variant of arterial supply to the paramedian thalamus and rostral midbrain, and occlusion of the artery of Percheron results in bilateral paramedian thalamic infarcts with or without midbrain involvement. Acute artery of Percheron infarcts represent 0.1 to 2% of total ischemic stroke. However, of thalamic strokes, occlusion of artery of Percheron is the cause in 4 to 35% of cases. Early diagnosis of artery of Percheron infarction can be challenging because it is infrequent and early computed tomography or magnetic resonance imaging may be negative. Thus, it can be confused with other neurological conditions such as tumors and infections.

Case presentation: This is a retrospective case study of a 56-year-old white man admitted to Umeå University Hospital and diagnosed with an artery of Percheron infarction. Medical records and the neuroradiological database were reviewed, and the diagnosis was made based on typical symptoms and radiological findings of artery of Percheron infarction. We report the case of a 56-year-old man with a history of overconsumption of alcohol who was found in his home unconscious and hypothermic. He had a Reaction Level Scale-85 score of 4. He developed ventricular fibrillation on arrival at our emergency department, and cardiopulmonary resuscitation successfully restored sinus rhythm within an estimated 2 minutes of onset. He was then put on cardiopulmonary bypass for rewarming. The initial head computed tomography performed on admission was wrongly assessed as unremarkable. Bilateral ischemia in the paramedian thalamic nuclei and pons were first documented on a follow-up computed tomography on day 24 after hospitalization. He died on day 35 after hospitalization.

Conclusions: Artery of Percheron infarcts are rare. The radiological diagnosis can initially often be judged as normal and in combination with variability in the neurological symptoms it is a rather difficult condition to diagnose. For these reasons few clinicians have much experience with this type of infarct, which may delay diagnosis and initiation of appropriate treatment.

Keywords: Artery of Percheron; Computed tomography; Infarct; Thalamus.

Fig. 1

a Head computed tomography (axial) performed on the day of admission was initially assessed as normal, although signs of bilateral ischemia in the thalami actually were visible. b Head computed tomography (coronal) performed on the day of admission was initially assessed as normal, but later re-evaluated to be bilateral ischemia in the thalami. c Head computed tomography (axial) performed on day 24 of hospitalization showed bilateral ischemia in the medial areas of the thalami. d Head computed tomography (coronal) performed on day 24 of hospitalization showed bilateral ischemia in the medial areas of the thalami

Fig. 2

Timeline of events during the hospital stay. CPR cardiopulmonary resuscitation, CT computed tomography, EEG electroencephalography