Artery of Percheron
Citation, DOI and article data
The artery of Percheron is a variant of the posterior cerebral circulation characterized by a solitary arterial trunk that supplies blood to the paramedian thalami and the rostral midbrain bilaterally. From the original classification of arterial patterns at the origin of the paramedian arteries for the thalamus 1, this variant is described as type II. Type I refers to the standard bilateral independent vascularization from the proximal segment of both posterior cerebral arteries while type III regards the existence of a communicating artery between these two independent origins, with either thalamus receiving bilateral arterial supply.
The artery of Percheron is estimated to occur in up to 33% of the population 2. Ischemic strokes affecting this artery are thought to be at the origin of 4-18% of all thalamic strokes 3.
The distribution of Percheron infarcts patterns involves3
- 43% - bilateral paramedian thalamic with midbrain
- 38% - bilateral paramedian thalamic without midbrain
- 14% - bilateral paramedian thalamic with anterior thalamus and midbrain
- 5% - bilateral paramedian thalamic with anterior thalamus without midbrain
The presentation of disease is dependent on the distribution of infarction, however the classic triad involves3
- altered mental status
- memory impairment
- vertical gaze palsy
The term is used to refer to a solitary arterial trunk that branches from one of the proximal segments of either posterior cerebral artery (PCA). It supplies blood to the paramedian thalami and, most often, the rostral midbrain bilaterally 4. Occasionally it supplies the anterior thalamus, particularly when the thalamotuberal (or polar) arteries are absent (30-60% of cases) 1,3.
History and etymology
It is named after the French neurologist Gérard Percheron, who described it in 1973 5.
- Percheron infarct: bilateral thalamic and mesencephalic infarctions; clinically patients are often obtunded, comatose, or agitated, with associated hemiplegia or hemisensory loss
- hyperintense signal along the midbrain surface adjacent to the interperduncular fossa
- seen on axial FLAIR and DWI images
- 67% sensitivity for Percheron infarction with midbrain involvement
Bilateral pathology of the thalamus include6
- primary neoplasm
- bilateral thalamic glioma (low-grade astrocytoma)
- metabolic and toxic disorders
- 1. Castaigne P, Lhermitte F, Buge A, Escourolle R, Hauw JJ, Lyon-Caen O. Paramedian thalamic and midbrain infarct: clinical and neuropathological study. (1981) Annals of neurology. 10 (2): 127-48. doi:10.1002/ana.410100204 - Pubmed
- 2. Uz A. Variations in the origin of the thalamoperforating arteries. (2007) Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 14 (2): 134-7. doi:10.1016/j.jocn.2006.01.047 - Pubmed
- 3. Lazzaro NA, Wright B, Castillo M, Fischbein NJ, Glastonbury CM, Hildenbrand PG, Wiggins RH, Quigley EP, Osborn AG. Artery of percheron infarction: imaging patterns and clinical spectrum. (2010) AJNR. American journal of neuroradiology. 31 (7): 1283-9. doi:10.3174/ajnr.A2044 - Pubmed
- 4. Matheus MG, Castillo M. Imaging of acute bilateral paramedian thalamic and mesencephalic infarcts. AJNR Am J Neuroradiol. 24 (10): 2005-8. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 5. Percheron G. The anatomy of the arterial supply of the human thalamus and its use for the interpretation of the thalamic vascular pathology. Z Neurol. 1973; 205: 1–13. Pubmed citation
- 6 Alice B. Smith, James G. Smirniotopoulos, Elisabeth J. Rushing, and Steven J. Goldstein. Bilateral Thalamic Lesions. American Journal of Roentgenology 2009 192:2, W53-W62