Artery of Percheron infarction in a 47-year-old male: A case report

Introduction/Objectives: The artery of Percheron (AOP) is a rare anatomic variation in the brain vascularization characterized by a single arterial trunk arising from the posterior cerebral artery (PCA) to supply both sides of the thalamus and midbrain. The incidence of AOP infarction is rare (varied from 0.1 to 2%) in all ischemic strokes. The aim of this report is to describe a rare case of stroke caused by occlusion of the AOP due to cardioembolism from a patent foramen ovale (PFO). Participants, Materials/Methods: A case report. Results: A 47-year-old man presented in our emergency department with sudden onset of vertigo, gait instability and rapid deterioration in consciousness. Initial brain computed tomography (CT) performed on admission was normal. Magnetic resonance imaging (MRI) showed ischemic lesions in bilateral thalami and mesencephalon. A magnetic resonance angiography (MRA) was performed and demonstrated an absent P1 segment of the right PCA, indicating type II variation of the artery of Percheron. The patient was admitted to the stroke unit where he was treated with acetylsalicylic acid and gradually regained consciousness. Upon hospital discharge, mild ataxia and vertical gaze palsy was present. In further evaluation of stroke etiology a patent foramen ovale (PFO) was confirmed. Conclusions: Occlusion of the AOP is uncommon which makes early diagnosis very challenging. A comprehensive radiologic examination, including MRI is necessary when severity of clinical features does not correlate with the standard imaging findings. Early diagnosis may lead to timely and adequate treatment and therefore more favorable outcomes.