Stroke due to Percheron Artery Occlusion: Description of a Consecutive Case Series from Southern Portugal

Abstract

The artery of Percheron (AOP) is an abnormal variant of the arterial supply of the thalamus. Stroke caused by AOP occlusion is seldom reported. AOP leads to bilateral thalamic and rostral midbrain infarct presenting with unspecific manifestations. There are few descriptions of case series of stroke caused by AOP. We sought to review the clinicoradiological characteristics of AOP infarction from Algarve, Southern Portugal. Eight consecutive cases were retrospectively identified by searching the electronic clinical charts, as well as the stroke Unit database (2015-2020). Sociodemographic (age and gender) and clinicoradiological characteristics (etiological classification, admission severity, manifestations, and short- and long-term prognoses) were retrieved. The corresponding frequency of AOP infarction was 0.17% (95% confidence interval: 0.05-0.28). The mean age was 67.1 (range: 60-80) years. The range of stroke severity evaluated assessed by the National Institute of Health Stroke Scale ranged from 5 to 23 (median = 7.5). None of the patients receive acute ischemic stroke reperfusion treatment. AOP patterns were isolated bilateral paramedian thalamic ( n = 2), bilateral paramedian and anterior thalamic ( n = 2), and bilateral paramedian thalamic with rostral midbrain ( n = 4). Two patients (20%) died on the short term (30 days). At hospital discharge, six patients had functional disability of ≤2 on the modified Rankin scale. In the follow-up at 6 months, half ( n = 3) of the survivors had persistent hypersomnia and two had vascular dementia. Stroke from AOP presents with variable clinical and radiological presentations and patients do not receive alteplase. The short-term survivor and the long-term functional independency can be compromised after AOS infarct.

Keywords: bithalamic infarct; ischemic stroke; paramedian thalamic infarct; the artery of Percheron.

Fig. 1

Representative radiologic appearance of the artery of Percheron infarction, bilateral paramedian lesions ( A ) hypodense on brain cranial tomography and ( B ) restriction on magnetic resonance (MR) diffusion-weighted imaging (DWI); combined bilateral thalamic lesion ( C ) with rostral mesencephalic on DWI MR ; combined anterior ( D ) with paramedian bilateral lesions on DWI MR.