title: Complex neurological symptoms in bilateral thalamic stroke due to Percheron artery occlusion.
abstract: The artery of Percheron is a rare anatomical variant where a single thalamic perforating artery arises from the proximal posterior cerebral artery (P1 segment) between the basilar artery and the posterior communicating artery and supplies the rostral mesencephalon and both paramedian territories of the thalami. Almost one-third of human brains present this variant. Occlusion of the artery of Percheron mostly results in a bilateral medial thalamic infarction, which usually manifests with altered consciousness (including coma), vertical gaze paresis, and cognitive disturbance. The presentation is similar to the "top of the basilar syndrome", and early recognition should be prompted. We describe the case of a young female with this vessel variant who experienced a bilateral thalamic stroke. Magnetic resonance angiography demonstrated bilateral thalamic infarcts and a truncated artery of Percheron. Occlusion of the vessel was presumably due to embolism from a patent foramen ovale. Thrombolysis was performed, with incomplete symptom remission, cognitive impairment, and persistence of speech disorders. Early recognition and treatment of posterior circulation strokes is mandatory, and further investigation for underlying stroke etiologies is needed.
authors.affiliation: Department of Clinical Neurology, University of Trieste, Trieste, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Caruso
authors.affiliation: Department of Clinical Neurology, University of Trieste, Trieste, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Manganotti
authors.affiliation: Department of Clinical Neurology, University of Trieste, Trieste, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Moretti
mesh_terms: D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography / Q000379:methods; D002536:Cerebral Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging; D003072:Cognition Disorders / Q000209:etiology; D000072226:Computed Tomography Angiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D020127:Recovery of Function; D013064:Speech Disorders / Q000209:etiology; D013788:Thalamus / Q000098:blood supply*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
keywords: cognitive impairment; paramedian thalamus territory; speech disorder; thalamus vascularization; vertical gaze palsy