One of the atypical and unusual presentations of ischemic stroke is an occlusion of the “artery of Percheron” (AOP) which leads to infarction of thalami and mesencephalon. AOP is a rare variant vessel, and its acute occlusion can cause a bilateral symmetrical thalamic stroke. Vertical gaze palsy, memory loss, disorientation, sleepiness, hypersomnolence, or comas are the usual symptoms of bilateral paramedian thalamic infarcts caused by the obstruction of AOP. There are several variants of thalamic blood supply, identifying the potential presence and infarction of an AOP is crucial for diagnosis and treatment of ischemic strokes affecting the thalami and mesencephalon, especially because of the unusual and variable presentation of these forms of ischemic strokes. We describe a case of a 61-year-old man who was otherwise healthy and experienced abrupt onset giddiness followed by loss of consciousness and was later identified with an AOP infarct.
Schmahmann JD. Vascular syndromes of the thalamus. Stroke 2003;34(9):2264–2278. DOI: 10.1161/01.STR.0000087786.38997.9E
Ranasinghe T, Boo S, Adcock A. Acute onset of hypersomnolence and aphasia secondary to an artery of percheron infarct and a proposed emergency room evaluation. Case Rep Emerg Med 2019;2019:1260865. DOI: 10.1155/2019/1260865
Matheus MG, Castillo M. Imaging of acute bilateral paramedian thalamic and mesencephalic infarcts. AJNR Am J Neuroradiol 2003;24(10):2005–2008. PMID: 14625223.
Percheron G. Les artères du thalamus humain. I.–Artère et territoire thalamiques polaires de l'artère communicante postérieure [Arteries of the human thalamus. I. Artery and polar thalamic territory of the posterior communicating artery]. Rev Neurol (Paris) 1976;132(5):297–307. PMID: 959701.
Monet P, Garcia PY, Saliou G, et al. [Bithalamic infarct: is there an evocative aspect? Radioclinical study]. Rev Neurol (Paris) 2009;165(2):178–184. DOI: 10.1016/j.neurol.2008.08.012
Smith AB, Smirniotopoulos JG, Rushing EJ, et al. Bilateral thalamic lesions. AJR Am J Roentgenol 2009;192(2):W53–W62. DOI: 10.2214/AJR.08.1585
Kaya AH, Dagcinar A, Ulu MO, et al. The perforating branches of the P1 segment of the posterior cerebral artery. J Clin Neurosci 2010;17(1):80–84. DOI: 10.1016/j.jocn.2009.03.046
Rabinstein AA. Update on treatment of acute ischemic stroke. Continuum (Minneap Minn) 2020;26(2):268–286. DOI: 10.1212/CON.0000000000000840
Li X, Agarwal N, Hansberry DR, et al. Contemporary therapeutic strategies for occlusion of the artery of Percheron: a review of the literature. J Neurointerv Surg 2015;7(2):95–98. DOI: 10.1136/neurintsurg-2013-010913
