Aug 12, 2016 infarction in the artery of percheron territory is a rare phenomenon in which occlusion of an unpaired perforating artery arising from the p1 segment on one side results in infarcts in the bilateral paramedian thalami with or without midbrain infarcts. A bilateral paramedian thalamic infarct due to an occlusion of the artery of percheron was revealed two days later by a new head computed tomography. We describe the case of a 40yearold male who developed this complication following reexploratory transsphenoidal surgery for a pituitary. Lazzaro na, wright b, castillo m, fischbein nj, glastonbury cm, hildenbrand pg, wiggins rh, quigley ep, osborn ag 2010 artery of percheron infarction. Sep 08, 2011 blood supply of thalami is from thalamo striate perforators, which arises from proximal portions of pcas. Further diagnostic procedures were performed to identify cardiovascular risk factors, which may have led to bilateral thalamic infarct. Small artery disease and cardioembolism were the most frequent stroke mechanisms in paramedian infarcts 4 carrera e. Its occlusion results in infarction of bilateral paramedian thalami and mesencephalon.
We report the clinical and mr imaging findings in a patient. Learning radiology cases spotters set 50 radiogyan. Case report the artery of percheron infarction after coronary. Percheron artery infarction in the differential diagnosis. Its occlusion results in infarction of bilateral paramedian thalami and mesencephalon 1. Bilateral thalamic stroke due to occlusion of the artery. Midbrain and bilateral paramedian thalamic stroke due to. Variations related to their origin are, 1 st is each side perforators arising separately from corresponding pcas.
Artery of percheron obstruction is a rare form of ischemic stroke, but recognition of the possible presence of an aop obstruction both clinically and in imaging is essential to the. Methods in this study, 168 consecutive patients with acute. Full text complex neurological symptoms in bilateral. Bilateral thalamus and mid brain infarction involving artery of percheron. The diagnosis of an artery of percheron infarction was. Bilateral thalamic stroke due to occlusion of the artery of. Although it also did not show evidence for artery of percheron aop occlusion it is not unusual as artery of percheron is rarely visible on angiomri or angioct or conventional angiography. We present here a fullterm male neonate, whose righthand sided clonic seizures on day of life 2 prompted neuroimaging, which revealed bilateral paramedian thalamic and mesencephalic infarcts, suggestive of an occlusion of the artery of percheron. Artery of percheron obstruction is a rare form of ischemic stroke, but recognition of the possible presence of an aop obstruction both clinically and in imaging is essential to the administration of timesensitive treatments, such as mechanical removal of the obstruction or tpas. Artery of percheron infarction after endoscopic pituitary surgery.
If you have the appropriate software installed, you can download article. Artery of percheron territory infarct radiology reference. Clinical presentations diagnostic challenge with a spectrum. They are the result of a complex combination of risk factors and a predisposing vessel distribution. Assessment of percheron infarction in images and clinical.
We present here a fullterm male neonate, whose righthand sided clonic seizures on dayoflife 2. To our knowledge, this is the first report in the literature of a symptomatic patient presenting an acute percheron stroke with normal early brain magnetic resonance imaging. Artery of percheron infarct aka paramedian thalamic syndrome. However, of thalamic strokes, occlusion of artery of percheron is the cause in 4 to 35% of cases. Bilateral paramedian thalamic and mesencephalic infarcts. Artery of percheron is a rare variation in blood supply in which a solitary arterial trunk arises from one of the proximal segments of the posterior cerebral arteries and supplies the. Early brain imaging and diagnosis is important for initiating appropriate treatment. The artery of percheron, characterized by a single arterial trunk that irrigates both paramedian thalamic regions, can be occluded as a result of embolic diseases leading to bilateral paramedian thalamic infarcts.
Cassourret g, prunet b, sbardella f, bordes j, maurin o, boret h 2010 ischemic stroke of the artery of percheron with normal initial mri. The artery of percheron is a variant which originates from the p1 segment of the posterior cerebral artery. Acute ischemia constitutes approximately 80% of all strokes and is an important cause. The artery of percheron aop arises from a common trunk of one p1 segment of the posterior cerebral artery pca and supplies the thalamus bilaterally 25 figure 1, number 7. The functions of the thalamus and midbrain include the regulation of consciousness, sleep and alertness. Ct scan of the brain viewed with ischemaview rapid neuroimaging software revealed no areas of infarct. We would like to draw the readers attention to a patient with occlusion of the artery of percheron.
Bilateral thalamic infarcts due to occlusion of the artery. The diagnosis of an artery of percheron infarction was therefore made retrospectively with the reexamination of the cta of neck and intracranial arteries. As part of the routine stroke work up, an echocardiogram showed evidence of left to right shunting. Occlusion of the artery of percheron mostly results in a bilateral. Multimodality imaging for spontaneous coronary artery.
The presentation of an infarct in this territory varies widely and is often characterized by nonspecific neurological deficits, with altered mental status, decreased level of consciousness, and memory impairment being among the. In 2 large stroke series, the characteristic artery of percheron infarct pattern was estimated to occur in 0. Artery of percheron territory infarct is rare, on account of the relative rarity of the artery of percheron, and. The artery of percheron infarction after coronary angiography. Artery of percheron infarction in a patient with atrial. Percheron artery infarction in the differential diagnosis of. Artery of percheron aop occlusion is a rare cause of ischemic stroke characterized by bilateral paramedian thalamic infarcts, with or without mesencephalic infarction. The primary imaging criterion for inclusion was an abnormal signal intensity on mr imaging andor hypoattenuation on ct involving distinct arterial zones of the bilateral paramedian thalami with or without rostral midbrain involvement.
Bilateral thalamic ischemic stroke secondary to occlusion. Archives ct perfusion of artery of percheron occlusion and thrombectomy beyond the m1 bread and butter cases, there is a good variety of excellent and more unusual scenarios that are very instructive. The artery of percheron aop is a variant of the paramedian thalamic vasculature that supplies blood to the medial aspect of the thalamus and the rostral midbrain. Bilateral thalamic infarcts due to occlusion of the artery of. Rapid neuroimaging software revealed no areas of infarct. Clinically it presents with mental state disturbances, hypersomnolence, aphasiadysarthria, amnesia and ocular movement disorders, including vertical gaze palsy. The routine mri performed 3 days after admission confirmed subacute infarction in bilateral thalami and anteromedial midbrain suggesting occlusion of the artery of percheron aop. The case described above demonstrates classic imaging findings of an ischemic stroke in the territory of the aop, an anatomic variant. The artery of percheron aop is a rare vascular variant in which a single dominant thalamoperforating artery arises from the p1 segment and bifurcates to supply both paramedian thalami. Stroke can be defined as an acute central nervous system injury with an abrupt onset. Archives ct perfusion of artery of percheron occlusion.
Bilateral thalamic infarcts due to occlusion of artery of. Anteromedian, central and posterolateral infarcts of the thalamus. T1w image showing hypointense lesion displacing the midbrain. Bilateral thalamic ischemic stroke secondary to occlusion of. Artery of percheron infarction is best visualized on dwi or flair sequences on mri and is often missed on initial ct. Spontaneous coronary artery dissection scad has gained attention as a key cause of acute coronary syndrome and sudden cardiac death among women. Bilateral paramedian thalamic and midbrain infarction due to.
The prevalence of the artery of percheron is unknown 1, 6. It happens as a result of an anatomical variant of the. The artery of percheron aop, a rare anatomic variant arising from segment one of the posterior cerebral artery p1 with a single common branch that provides bilateral arterial supply to the. This sign appears on axial views of dwi and flair sequences as an area of vshaped hyperintensity. When the socalled artery of percheron is occluded, the bithalamic infarcts are paramedian, relatively symmetrical. We report the clinical and mr imaging findings in a patient who developed infarction in the typical distribution of the artery of percheron. Aop is a variant posterior circulation that supplies the paramedian thalami and rostral midbrain.
Stateoftheart imaging of acute stroke radiographics. Susceptibilityweighted imaging in differentiating bilateral. These noninvasive techniques are useful in initial screening for coronary artery stenosis, evaluating bypass grafts and determining the patency of infarct. In other studies the characteristic artery of percheron infarct pattern was estimated. Moreover, in their work, the v sign for the diagnosis of percheron artery was described. Objective to characterise the topographic patterns of thalamic infarcts associated with various stroke syndromes and aetiologies. Diagnosing an artery of percheron infarction is critical for directing the appropriate time sensitive management and preventing additional unnecessary. The occlusion of the artery of percheron aop is a rare condition that causes bilateral thalamic ischemic stroke with or without midbrain involvement. Several hours after sameday discharge from the hospital, he suddenly became comatose, requiring intubation and admission to the. Artery of percheron infarction as an unusual cause of.
Artery of percheron infarction fulltext annals of neurosciences. The artery of percheron aop is a rare anatomical variation in the brain vascularization in which a single arterial trunk arises from the posterior cerebral artery pca to supply both sides of the thalamus and. Diagnosing an artery of percheron infarction is critical for directing the appropriate time sensitive management and preventing additional unnecessary procedures. A case of midbrain and thalamic infarction involving artery. Other imaging modalities were not performed, due to the presumption that the window for. Artery of percheron infarction after endoscopic pituitary. To summarise the aetiology, clinical manifestations, imaging, treatment and prognosis of one case and bilateral thalamus infarction caused by aop occlusion. Accurate diagnosis of scad through use of imaging is critical, as emerging evidence suggests that the optimal short and longterm management.
Jul 07, 2016 artery of percheron aop occlusion is a rare cause of ischemic stroke characterized by bilateral paramedian thalamic infarcts, with or without mesencephalic infarction. Infarction of the territory of the artery of percheron applied radiology. One uncommon type of ischemic stroke is occlusion of the artery of percheron aop leading to infarction of the paramedian thalami and mesencephalon. Recent advancements in cardiac imaging have improved identification and accelerated awareness of scad. 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. Percheron studied thalamic vascularization and described three anatomical variations. It happens as a result of an anatomical variant of the diencephalic irrigation, in which the thalamic paramedian arteries arise from a common trunk from the posterior cerebral artery pca, which generates a clinical syndrome characterized by. Bilateral paramedian thalamic and midbrain infarction due. Infarction in the artery of percheron territory is a rare phenomenon in which occlusion of an unpaired perforating artery arising from the p1 segment on one side results in infarcts in the.
Ischemic stroke of the artery of percheron with normal. Copyright 2020 dove press ltd software development by web design by adhesion. Blood supply of thalami is from thalamo striate perforators, which arises from proximal portions of pcas. Artery of percheron territory infarct radiology reference article. Delayed sudden coma due to artery of percheron infarction. Although some improvement of these symptoms does occur, complete recovery is rare. Methods of 6539 patients with a firstever stroke, 18 patients with a percheron infarction were enrolled, and their images and clinical data were retrospectively investigated. Partially thrombosed aneurysm on the descending thoracic aorta. Jun 01, 20 the artery of percheron is a variant which originates from the p1 segment of the posterior cerebral artery.
Occlusion of the aop results in a characteristic pattern of ischemia. The midbrain v sign is a feature demonstrated on 67% of patients with the artery of percheron infarctions involving the midbrain. A 52yearold man was noted to display unusual behavior with transient agitation and blurry vision after otherwise uneventful diagnostic cardiac catheterization. Bilateral thalamic infarcts are rare presentations of stroke. Other imaging modalities were not performed, due to the presumption that the window for the application of effective therapy was over. Occlusion of the common trunk leads to typical mirrorlike symmetric bilateral thalamic infarctions which can be considered pathognomonic of occlusion of the artery. Complex neurological symptoms in bilateral thalamic stroke due to. Imaging patterns and clinical spectrum article pdf available in american journal of neuroradiology 317.
Topographic patterns of thalamic infarcts in association. Sep 15, 2009 bilateral thalamic infarcts are rare presentations of stroke. Mri of the brain done later revealed hyperintensities in bilateral paramedian thalami and. Artery of percheron territory infarct is rare, on account of the relative rarity of the artery of percheron, and presents with a variety of signs and symptoms collectively termed the paramedian thalamic. To assess the imaging and clinical features of patients with an artery of percheron infarction comprehensively. Case report the artery of percheron infarction after. Variations related to their origin are, 1 st is each side perforators arising separately. The left side image shows an artery of percheron aop, wherein the perforator arteries are either absent altogether or are severely hypo plastic and the above said areas of the thalamus and mid brain are supplied by small perforator branches which arise from a solitary artery which usually arises from the p1 segment of the posterior cerebral.
Mar 02, 2020 artery of percheron infarct aka paramedian thalamic syndrome. Case report bilateral thalamic infarcts because of the. Diffusion weighted imaging dwi of brain showed symmetrical diffusion restricted lesions at bilateral paramedian rostral. Brain ct scan examination was immediately obtained, and no acute. Arauz a, patinorodriguez hm, vargasgonzalez jc, arguellesmorales n, silos h, ruizfranco a, ochoa ma 2014 clinical spectrum of artery of percheron infarct. To investigate the aetiology, clinical features and imaging characteristics of bilateral thalamus infarction caused by artery of percheron aop occlusion. The left side image shows an artery of percheron aop, wherein the perforator arteries are either absent altogether or are severely hypo plastic and the above said areas of the thalamus and mid brain are. Conventional mri and diffusionperfusionweighted imaging confirmed the presence of the infarcts 6 click here to see the library. The primary imaging criterion for inclusion was an. Initial ct of the brain at admission was unremarkable. As part of the routine stroke work up, an echocardiogram showed evidence of left to right shunting suggestive of a patent foramen ovale, which was closed during his hospitalization. The artery of percheron aop is a rare anatomical variation in the brain vascularization in which a single arterial trunk arises from the posterior cerebral artery pca to supply both sides of the thalamus and midbrain.
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