Artery of Percheron infarction

Case contributed by Dr Naushad Ali Basheer Ahamed

Presentation

Decreased level of counsiousness, with impaired horizontal gaze

Patient Data

Age: 80 years
Gender: Male
Modality: CT

Unenhanced axial CT scan shows rounded areas of low attenuation, bilaterally in the medial thalami and midbrain.

Non-Contrast MRI of the brain with TOF MRA

Modality: MRI

See below

Modality: Diagram

This is an illustrated drawing.

The right side image shows the prevalent anatomy wherein the multiple perforator branches of the basilar artery the medial thalami and the ventral mid brain, corresponding to a particular peculiar zone.

The left side image shows an Artery of Percheron (AOP), wherein the perforator arteries are either absent altogether or are severely hypo plastic and the above said areas of the thalamus and mid brain are supplied by small perforator branches which arise from a solitary artery which usually arises from the P1 segment of the Posterior Cerebral Artery (PCA).

It has been reported that a right AOP is a more common than the left side origin.

Case Discussion

The AOP is a vascular anomaly wherein a single arterial branch arises from the PCA circulation to supply the midbrain and thalamus.

The AOP was first described  by the French medical scientist Gerald Percheron in 1973.

The multiple perforator beaches which usually arise from the basilar artery are replaced by beaches from this singleton brach of the posterior cerebral artery. An occlusion of this brach lead to a peculiar type of brain stem infarction with characteristic imaging findings as described.

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Case Information

rID: 28679
Case created: 7th Apr 2014
Last edited: 21st Oct 2015
Inclusion in quiz mode: Included

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