Artery of Percheron territory infarct

Case contributed by Dr RajaRajan

Presentation

Altered sensorium, vertical gaze palsy and memory impairment.

Patient Data

Age: 80 years
Gender: Female

Diffusion weighted hyperintensity with corresponding low ADC signal and FLAIR hyperintensity in bilateral paramedian thalami. Features consistent with subacute infarct confined to the artery of Percheron territory.

Case Discussion

Bilateral thalamic infarcts are not common. Paramedian thalami are most commonly affected location. Infarcts are asymmetrical and caused by multiple emboli or small artery disease. Artery of Percheron occlusion results in bilateral medial thalamic and rostral mesencephalic infarctions with a relatively symmetrical distribution. When the artery of Percheron is occluded, the thalamic infarcts are always bilateral and medial.

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