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Case Report

Artery of Percheron occlusion: role of

diffusion‑weighted imaging in the early diagnosis

Murali Krishna Menon , Suma Mariam Jacob , Muhammed Jasim Abdul Jalal 3
2
1
1 Department of Neurology, Lakeshore Hospital and Research Centre, Ernakulam 682040, Kerala, India.
2 Department of Radiology, Lakeshore Hospital and Research Centre, Ernakulam 682040, Kerala, India.
3 Department of Family Medicine, Lakeshore Hospital and Research Centre, Ernakulam 682040, Kerala, India.
Dr. Murali Krishna Menon, Dr. Suma Mariam Dr. Muhammed Jasim
an exceptionally talented Jacob is an expert in Abdul Jalal, a Family
Neurologist, with more than Radiology. Trained Physician, trained in
20 years of experience, Dr. extensively from General Medicine,
Murali Krishna Menon is an CMC Vellore, India, General Surgery, Women
expert in the management she has an experience and Child health and
of complex neurological of 15 years in Preventive Medicine. He
problems and emergencies advanced Radiology. believes in the concept
including stroke. His fields of medical care with a
of special interest include preventive and holistic
Movement Disorders, approach. He has special
Parkinsonism, Dementia interest in Clinical
and Headache. Neurology.
A B S T R AC T

Bilateral thalamic infarcts have a low frequency among different subtypes of strokes. Since it does not involve a particular vascular territory, it
therefore usually involves the occlusion of the artery of Percheron (AOP). Here we report a 79‑year‑old right‑handed Parkinsonian female patient,
who was found unresponsive in bed. On examination, the patient was drowsy with a Glasgow Coma Score (GCS) of 10/15 (E2M5V3). She had
absent doll’s eye response with anisocoric pupils and intermittent vertical gaze palsy. Although the patient had no apparent motor deficits, she
was in a state of persistent somnolence with memory impairment and lack of initiative. Diffusion‑weighted magnetic resonance imaging (MRI) of
the brain showed focal areas of restricted diffusion in the medial part of the thalami bilaterally and the rostral part of mid‑brain (right > left) (bilateral
paramedian thalamic with mid‑brain pattern), suggestive of a hyper‑acute infarct in the territory of AOP. The patient was anticoagulated with 40 mg
subcutaneous low molecular weight heparin and was started on double anti‑platelets along with supportive measures. The level of consciousness
is improved at a slow rate to a GCS of 12/15 (E4M5V3). The patient had marked abulia with periods of drowsiness interspersed with periods of
restlessness and uttering of abnormal sounds, but she was able to execute simple commands. In conclusion, occlusion of the AOP is a rare cause
of coma in elderly patients. Diffusion‑weighted MRI is the imaging modality of choice for early diagnosis. Early diagnosis of AOP occlusion may
lead to favorable outcomes.

Key words: Artery of Percheron; bilateral thalamic infarcts; coma; diffusion‑weighted imaging; thalamic dementia

INTRODUCTION out to the occlusion of the artery of Percheron (AOP).
[1]
AOP is a solitary arterial trunk which arises from one of
Bilateral thalamic infarcts have a low frequency among the proximal segments of the posterior cerebral artery and
different subtypes of strokes. These infarcts involve the supplies the thalamus and certain structures of the rostral
medial aspects of the thalamus in a relatively symmetrical midbrain. The low sensitivity of computed tomography
pattern with or without simultaneous involvement of the (CT) makes AOP infarction diagnosis difficult.
rostral mid‑brain bilaterally. Since it does not involve any Diffusion‑weighted magnetic resonance imaging (MRI) is
[1]
of the particular vascular territories, this usually points the imaging modality of choice. However, AOP is rarely
visualized on magnetic resonance angiography, and lack
of visualization does not exclude its presence. The
[1]
Corresponding Author: Dr. Muhammed Jasim Abdul Jalal,
Department of Family Medicine, Lakeshore Hospital and incidence of AOP occlusion is rare, and early diagnosis
Research Centre, Maradu, NH 47‑Byepass, Ernakulam 682040,
Kerala, India.E‑mail: poolspuff@gmail.com This is an open access article distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows
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Cite this article as: Menon MK, Jacob SM, Jalal MJ. Artery of Percheron
occlusion: role of diffusion‑weighted imaging in the early diagnosis.
Neuroimmunol Neuroinflammation 2016;3:14-6.
DOI: 10.4103/2347‑8659.169916
Received: 09-07-2015; Accepted: 01-10-2015

14 © 2016 Neuroimmunology and Neuroinflammation | Published by OAE Publishing Inc.