Artery of Percheron infarction
Patient is presented with sudden onset of ptosis and ophthalmoplegia . He is a known patient with diabetes mellitus , ischaemic heart disease and congestive cardiac failure. Echo cardiography showed severe left ventricular dysfunction ( Ejection fraction is 20%) and left ventricular clots.
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T1 hypo and T2,FLAIR hyper intense abnormal signal changes with diffusion restriction are seen in the bilateral medial thalami and mid brain. Vertebral arteries and basilar artery are normal in MR angiogram. Cerebral venous sinuses are normal.
Diagnosed as an acute infarction of bilateral medial thalami and midbrain due to artery of artery of Percheron occlusion.
This patient's embolus was presumably from identified left ventricular thrombus.
The thalamus is supplied by multiple small vessels originating from the Posterior communicating arteries and P1 and P2 segments of the posterior cerebral arteries. The artery of Percheron is a normal variant, it is characterised with single arterial trunk arising from posterior cerebral artery and supplies to bilateral paramedian thalami and rostral midbrain 1.
Occlusion of an artery of Percheron leads to bilateral paramedian thalamic infarcts with or without midbrain involvement 1.
Differential diagnoses include 1:
- Top of the basilar artery syndrome.
- Bilateral internal cerebral venous thrombosis and
- Bilateral thalamic glioma
- 1.N.A. Lazzaro, B. Wright, M. Castillo, N.J. Fischbein, C.M. Glastonbury, P.G. Hildenbrand, R.H. Wiggins, E.P. Quigley, and A.G. Osborn et-al. Artery of Percheron Infarction: Imaging Patterns and Clinical Spectrum. AJNR Am J Neuroradiol 31:1283– 89;Aug 2010; www.ajnr.org