Presentation
Acute presentation: CN VIII fallout and right sided facial parasthesia.
Patient Data
Age: 40 years
Gender: Male
From the case:
Artery of Percheron infarction
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FLAIR hyperintense signal in bilateral paramedian thalami with medial mesencephalic extension. Corresponding restricted diffusion. No enhancement or susceptibility to suggest necrosis yet - which is consistent with the acute presentation. Absence of PCA and SCA involvement confirming artery of Percheron infarction.
Case Discussion
Differential diagnoses to consider are;
- diffuse glioma, however, there is no asymmetry in the T2 hyperintensity,
- lymphoma - no enhancement noted
- top of the basilar syndrome - no PCA or SCA involvement
- hypoxic-ischemic-encephalopathy - basal ganglia are unaffected
- deep cerebral venous thrombosis - often accompanied by hemorrhage, which is absent here
- Wernicke's encephalopathy - mammillary, hypothalamic and PAG involvement is not seen
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