Title : Decrease in sensorium in a 43-year-old male: A case report of artery of percheron infarction
Abstract:
Background: Thalamus is situated at the rostral end of the brainstem and its important function is to relay information as well as an integrative station for information passing to all areas of the cerebral cortex, the basal ganglia, the hypothalamus, and the brainstem. Artery of Percheron (AOP) is an anatomic variant that supplies the bilateral paramedian thalami and rostral midbrain. Acute artery of Percheron infarcts represent only 0.4-0.5% of total ischemic strokes. Infarct in the area of AOP can present with altered mental status, memory impairment, and oculomotor dysfunction. MRI is the diagnostic imaging of choice and shows hyperintensity signal in the distribution of AOP. Treatment includes thrombolysis and intravenously administered heparin and long-term anticoagulants.
Narrative: A case of 43-year old male who was brought to the emergency department due to unresponsiveness. GCS 7 (E1V1M5), intubated, isocoric pupils with noted medial rectus palsy, and able to follow command. Initial Cranial CT angiogram and Cranial CT scan plain were requested however unremarkable. Lumbar tap was also done to rule out infectious process however with normal laboratory result and no microorganism seen on CSF culture. Repeat Cranial CT scan plain was done revealing subacute bithalamic and rostral midbrain infarct, Artery of Percheron territory. Antiplatelet was started and was continued as maintenance medication.
Discussion: Artery of Percheron infarcts are rare. The radiological diagnosis can initially often be judged as normal and in combination with variability in the neurological symptoms it is a rather difficult condition to diagnose. Due to diversity and inconsistency in presentation and lack of localizing signs, it causes delay in diagnosis and initiation of appropriate treatment.
