Artery of Percheron infarction

Case contributed by Coenraad Hattingh


Acute presentation: CN VIII fallout and right sided facial parasthesia.

Patient Data

Age: 40 years
Gender: Male

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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