Artery of Percheron Infarct with a Normal Initial MRI: A Case Report

Case Presentation

Austin Emerg Med. 2016; 2(9): 1047.

Artery of Percheron Infarct with a Normal Initial MRI: A Case Report

Dias Ayesha M¹* and Rekha²

¹Department of Emergency Medicine, St John’s Medical College Hospital, Bangalore, India

²Department of Radiology, St John’s Medical College Hospital, Bangalore, India

*Corresponding author: Ayesha Maria Dias, Department of Emergency Medicine, St John’s Medical College Hospital, Bangalore, India

Received: November 13, 2016; Accepted: December 07, 2016; Published: December 09, 2016

Abstract

The artery of Percheron is a rare anatomical variant which supplies both the paramedian thalamic and the rostral midbrain. This unique feature is responsible for bilateral thalamic and mesencephalic infarctions if occluded. A single occlusion can lead to a clinical picture of drowsiness and visual disturbances due to the bilateral nature of the structures supplied.

We report a case of a patient in altered sensorium with normal early imaging (CT and MRI). Ischemia in the region of the artery of Percheron was revealed three days later with a repeat Magnetic Resonance Imaging. This is one of the few cases reported where early imaging fails to detect an acute stroke in a symptomatic patient.

Keywords: Artery of Percheron; Stroke; Thalamus; Coma

Introduction

The thalamus receives a complex blood supply from the anterior, posterior, inferolateral and paramedian arteries [1,2]. The paramedian thalamic arteries can arise from the P1 segment of the posterior cerebral artery in three different ways. The commonest variation is when it arises from the P1 segment of each PCA. If the perforating arteries arise from a single common trunk which supplies both thalami across the midline this variation is the artery of Percheron (Figure 1). Occlusion of this artery produces paresis of upward gaze, drowsiness and often coma [3]. Imaging modalities are pivotal in identification for thrombolysis in acute stroke.