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Case Reports
. 2023 Jun 27;18(9):3157-3161.
doi: 10.1016/j.radcr.2023.06.015. eCollection 2023 Sep.

Artery of Percheron infarction presented with isolated downgaze paralysis: A case report

Mohamed Hamid  1 , Aziz Ahizoune  1
Affiliations
Case Reports

Artery of Percheron infarction presented with isolated downgaze paralysis: A case report

Mohamed Hamid et al. Radiol Case Rep. .

Abstract

Isolated downgaze paralysis is the most infrequent expression of vertical gaze abnormalities. Vertical eye movements are controlled by nuclei and circuits located in the thalamic-mesencephalon region, and more particularly the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). The Artery of Percheron (AP) is a rare vascular anatomic variation that supplies the paramedian region of the thalami and the rostral portion of the mesencephalon. We present a unique case of isolated downgaze paralysis caused by AP ischemia.

Keywords: Artery of Percheron; Downgaze paralysis; Midbrain; Stroke; Thalamus.

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Figures

Fig1
Fig.1
Extraocular eye movements in all cardinal points. Note the downgaze paralysis.
Fig 2
Fig. 2
Cranial MRI on axial DWI (A) and FLAIR (B) sequences demonstrated high signal intensity on bilateral paramedian thalami (arrows).
Fig 3
Fig. 3
Cerebral MRI on coronal T2 (A) and axial FLAIR (B) sequences showed hyperintensity on the rostral midbrain (arrows).
Fig 4
Fig. 4
MRA demonstrated an abnormal small vessel emerging from the P1 segment of the right PCA (arrow).
Fig 5
Fig. 5
MRI control on axial FLAIR sequence (A) showed lacunar infarct of bilateral paramedian thalami (arrows). Sagittal T1 sequence (B) found low signal intensity in the rostral mesencephalon (arrow).
See this image and copyright information in PMC

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