Artery of Percheron territory infarct

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 syndrome. It is a type of posterior circulation infarction.

On imaging, it is classically characterised by bilateral infarcts in areas involving the rostral midbrain and/or ventromedial thalamus.

The symptoms may vary following infarct extension through thalamic or mesencephalic structures 2:

  • bilateral paramedian thalamic involvement is usually characterised by a triad of altered mental status, vertical gaze palsy, and memory impairment
  • when also accompanied by rostral midbrain lesions, a mesencephalothalamic or thalamopeduncular syndrome occurs, which includes other oculomotor disturbances, hemiplegia, cerebellar ataxia, and movement disorders, along with the triad mentioned above

There are four major patterns of artery of Percheron infarction, all of which bilaterally involve the paramedial thalamus 2, 3:

  • bilateral paramedial thalamic and midbrain infarction (most common)
  • isolated bilateral paramedial thalamic infarction
  • bilateral paramedial thalamic and anterior thalamic infarction
  • bilateral paramedial thalamic, anterior thalamic and midbrain infarction (least common)  

Artery of Percheron infarction is best visualised on DWI or FLAIR sequences on MRI and is often missed on initial CT.  The midbrain V sign is a feature demonstrated on 67% of patients with artery of Percheron infarctions involving the midbrain. This sign appears on axial views of DWI and FLAIR sequences as an area of V-shaped hyperintensity on the pial surface of the midbrain that forms the posterior wall of the interpeduncular fossa 2.

Described by the French neurologist Gérard Percheron in 1973.

Possible differential considerations include:

Stroke and intracranial haemorrhage
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Article information

rID: 13109
Section: Gamuts
Tag: infarct
Synonyms or Alternate Spellings:
  • Percheron infarct
  • Percheron artery infarct
  • Percheron infarction
  • Percheron artery infarction
  • Artery of Percheron infarction
  • Artery of Percheron infarct

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