A case of posterior cerebral artery occlusion that developed into an artery of Percheron infarction

Abstract

The thalamus is predominantly supplied by multiple small vessels originating from the posterior communicating artery and the P1 and P2 segments of the posterior cerebral artery (PCA). The artery of Percheron (AOP) is a rare anatomical variant of arterial supply to the thalamus. This single thalamic perforating branch supplies the bilateral thalamus so that occlusion results in a characteristic cerebral infarction. Herein, we report a case of posterior cerebral artery occlusion that developed into an AOP infarction. A 74-year-old man, who had undergone coronary artery bypass grafting 5 days previously presented with sudden consciousness disorder and tetraplegia, and was admitted to our hospital. Magnetic resonance imaging (MRI) revealed a hyper-intense area in the bilateral paramedian thalamus on diffusion-weighted imaging and a deficit of the left PCA on MR angiography (MRA). The patient was diagnosed with cardiogenic cerebral embolism, and immediately underwent mechanical thrombectomy (MT), thereby complete recanalization was obtained. Post-procedural MRI showed no new lesions, and the left PCA could keep patency. His consciousness disorder and tetraplegia improved; however, cognitive impairment and vertical gaze palsy persisted as sequelae. To the best of our knowledge, such cases have not been previously reported. Additionally, in this case, we were able to identify an AOP on digital subtraction angiography, which was considered to be the responsible artery.

Keywords

• Mechanical thrombectomy
• Bilateral paramedian thalamic infarction
• Artery of Percheron
• Cognitive impairment
• Vertical gaze palsy