title: Bilateral thalamic stroke due to occlusion of the artery of Percheron in a patient with a patent foramen ovale.
abstract: The artery of Percheron (AOP) is a rare vascular variant in which a single dominant thalamoperforating artery arises from the P1 segment and bifurcates to supply both paramedian thalami. Occlusion of this uncommon vessel results in a characteristic pattern of bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report a case of a 37-year-old man with acute bilateral thalamic infarcts. The scans revealed symmetric bilateral hyperintense paramedian thalamic lesions consistent with an acute ischemic event. The posterior circulation was patent including the tip of the basilar artery and both posterior cerebral arteries, making the case compatible with occlusion of the AOP. This type of infarct is associated with embolic phenomena, and further evaluation revealed a patent foramen ovale as the source of emboli in the cerebrovascular circulation. The occlusion of the AOP is a rare cause of coma in young patients, and early recognition of this rare disease entity may lead to more favorable outcomes.
authors.affiliation: Department of Internal Medicine, St. Michael's Medical Center, Newark, New Jersey, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Jumean
authors.affiliation: Department of Internal Medicine, St. Michael's Medical Center, Newark, New Jersey, USA.
authors.forename: Ahmad Abu
authors.initials: AA
authors.lastname: Arqoub
authors.affiliation: Department of Internal Medicine, St. Michael's Medical Center, Newark, New Jersey, USA.
authors.forename: Moayad Awni
authors.initials: MA
authors.lastname: Al Hadidi
authors.affiliation: Department of Internal Medicine, St. Michael's Medical Center, Newark, New Jersey, USA.
authors.forename: Amer
authors.initials: A
authors.lastname: Hawatmeh
authors.affiliation: Department of Internal Medicine, Hematology and Oncology, St. Michael's Medical Center, Newark, New Jersey, USA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Shaaban
keywords: Artery of Percheron; bilateral thalamic infarcts; patent foramen ovale