Artery of Percheron Infarction: A Rare But Important Cause of Bilateral Thalamic Stroke

Abstract

Artery of Percheron infarction is a serious but rare condition that can result in acute bilateral thalamic infarction and a wide range of neurological symptoms. It occurs due to occlusion of the single arterial branch that supplies the medial thalamus and rostral midbrain bilaterally. In this case report, we describe a 58-year-old female with a history of hypertension and hyperlipidemia who presented with sudden confusion, speech difficulties, and right-sided weakness. An initial CT scan showed ill-defined hypodensity in the left internal capsule, which, when combined with the clinical features, suggested acute ischemic stroke. The patient received an IV tissue plasminogen activator within the recommended time window. Several days later, repeated imaging showed bilateral thalamic hypodensity consistent with subacute infarction in the territory of the artery of Percheron. The patient was subsequently discharged to a rehabilitation facility for further recovery and rehabilitation with residual mild hemiparesis. It is important for healthcare providers to maintain a high index of suspicion for the artery of Percheron infarction and be aware of its potential to cause acute bilateral thalamic infarction and a variety of neurological symptoms.

Keywords: artery of percheron; bilateral thalamic; case report; computed tomography; hemiparesis; magnetic resonance imaging; stroke.

Figure 1. Axial CT scan of the head demonstrating ill-defined hypodensity in the posterior limb of the left internal capsule (arrow), indicative of acute ischemic stroke, in correlation with clinical findings of right hemiparesis.

Figure 2. Coronal CT head image demonstrates bilateral thalamic hypodensity (arrows), which is highly suggestive of artery of Percheron infarction.

Figure 3. Diffusion-weighted imaging (A) reveals restricted diffusion in the bilateral thalami (arrows), and MR angiography (B) shows a single arterial trunk (arrow) supplying the thalami, which is consistent with the artery of Percheron infarction.

MR: magnetic resonance