Original Article
Clinical Spectrum of Artery of Percheron Infarct: Clinical–Radiological Correlations

https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.09.011Get rights and content

Background

The occlusion of the artery of Percheron results in bilateral thalamic and mesencephalic infarctions. In this series, we attempted to classify the subtypes of clinical presentations and long-term prognosis with regards to radiological patterns.

Methods

We sought the clinical and radiological findings of 15 (8 men and 7 women; mean age 48 years) consecutive patients with Percheron artery infarct over 10 years. We classified the clinical symptoms according to the presence of a mental status disturbance (MSD), behavioral amnesic impairment (BAI), aphasia/dysarthria, ocular movement disorders (OMDs), motor deficit, cerebellar signs, and others. The Percheron artery infarct images were classified as bilateral paramedian thalamic with rostral midbrain infarction (BPTRMI), bilateral paramedian thalamic without midbrain infarction (BPTWMI), bilateral paramedian and anterior thalamic with midbrain infarction (BPATMI), and bilateral paramedian and anterior thalamic without midbrain infarction. The outcome was evaluated using a modified Rankin Scale (mRS).

Results

OMD and MSD were the most common clinical manifestations in patients with BPTRMI (n = 8). BAI and MSD were the main clinical findings in patients with BPTWMI (n = 6). A patient with BPATMI had a combination of clinical manifestations. After a mean follow-up of 55 months, a good outcome (mRS score ≤ 2) was present in 25% of the patients with BPTRMI, 67% of the patients with BPTWMI, and in 1 patient with BPATMI.

Conclusions

Our findings suggest that it is possible to identify clinical and radiological subgroups of Percheron artery infarct. The long-term follow-up outcome is generally good, except in cases with midbrain involvement.

Section snippets

Background

The blood supply to the human thalami is complex and has multiple variants. The artery of Percheron is one of those variants and is characterized by a solitary arterial trunk that branches from one of the proximal segments of either of the posterior cerebral arteries (Fig 1) and supplies blood to the paramedian thalami.1 This type of variation is present in 4%-12% of the population.2, 3, 4, 5, 6, 7 Occlusion of this artery is rare and results in a bilateral paramedian thalamic infarction that

Patients and Methods

We studied 15 consecutive patients with Percheron artery infarct, as diagnosed by both CT and MRI, who were admitted to our stroke clinic over 10 years. Patients were included in the current series if there was evidence of a first-ever bilateral simultaneous paramedian thalamic infarct using standard axial, sagittal, and coronal MRI sequences. We excluded patients with an isolated thalamic infarct, infarct of the cerebral posterior artery, basilar thrombosis, and cerebral deep venous

Results

There were 15 patients (8 men and 7 women; mean age ± SD = 48 ± 14 years) with Percheron artery infarct (.4% of 3750 patients with a first-ever ischemic stroke). Table 1 shows the risk factors and clinical findings for all the cases. Hypertension was present in 5 patients (33%), current smoking in 4 (26%), patent foramen ovale in 3 (20%), and diabetes mellitus in 2 (13%). None of the patients had previous transient ischemic attacks.

The presumed cause of Percheron artery infarct was small-vessel

Discussion

Our series is an MRI-based study on the clinical findings of a Percheron artery infarct. In our stroke registry, they were found in .4% of patients with a first-ever stroke. The prevalence of Percheron artery is unknown. A small study of 15 cadaver brains demonstrated the Percheron artery in 1 specimen.4 To date, the diagnosis of Percheron artery infarct has been uncommon. In 2 large stroke series, the characteristic Percheron artery infarct pattern was estimated to occur in .1% and .3% of all

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    Conflict of interest: None.

    Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    Ethics approval: National Institute of Neurology and Neurosurgery ethics committee.

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