title: Lesson of the month 1: Artery of Percheron occlusion - an -uncommon cause of coma in a middle-aged man.
abstract: Bilateral paramedian thalamic infarction resulting from artery of Percheron occlusion presents with a distinct clinical syndrome comprising impaired consciousness, often with vertical gaze palsy and memory impairment. This uncommon anatomical variant arises as a single artery supplying both paramedian thalami. Early recognition can be challenging in the obtunded patient, where the differential diagnosis is broad. The acute physician should consider this diagnosis in a patient presenting with unexplained coma so that emergent treatments such as thrombolysis can be employed. Early imaging with computerised tomography can often be normal; therefore the use of magnetic resonance imaging is essential in confirming the diagnosis.
authors.affiliation: Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK james.bailey5@nhs.net.
authors.forename: James
authors.initials: J
authors.lastname: Bailey
authors.affiliation: Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Kayvan
authors.initials: K
authors.lastname: Khadjooi
mesh_terms: D002544:Cerebral Infarction; D002561:Cerebrovascular Disorders; D003128:Coma / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013788:Thalamus / Q000098:blood supply / Q000473:pathology
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