Artery of Percheron Infarction: A Characteristic Pattern of Ischemia and Variable Clinical Presentation: A Literature Review | Bentham Science
Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
TECHNICAL NOTE

Artery of Percheron Infarction: A Characteristic Pattern of Ischemia and Variable Clinical Presentation: A Literature Review

Author(s): Osama Kheiralla*, Salem Alghamdi, Rowa Aljondi, Abdulrahman Tajaldeen and Adel Bakheet

Volume 17, Issue 5, 2021

Published on: 30 November, 2020

Page: [669 - 674] Pages: 6

DOI: 10.2174/1573405616666201130095801

Price: $65

Open Access Journals Promotions 2
Abstract

The Artery of Percheron (AOP) is an uncommon anatomic variant that provides arterial supply to the paramedian region of the thalami and bilaterally to the rostral part of the midbrain; it is a solitary arterial trunk that branches from a proximal segment of the posterior cerebral artery (PCA). Although AOP infarction results in a characteristic pattern of ischemia—namely bilateral paramedian thalamic infarct with or without midbrain involvement—it may cause diagnostic difficulties due to the variety of its clinical presentations and wide differentials, as well as its small diameter and the difficulty of obtaining visualization through diagnostic imaging. Early neuroimaging of AOP infarction and correct diagnosis are mandatory for early initiation of the appropriate treatment and better patient outcomes. In this study, we discuss imaging the patterns of AOP infarction and its differentials and clinical presentation.

Keywords: Artery of percheron, infraction, paramedian, thalamus, midbrain, posterior cerebral artery.

Graphical Abstract

[1]
Agarwal N, Chaudhari A, Hansberry DR, Prestigiacomo CJ. Redefining thalamic vascularization vicariously through gerald percheron: a historical vignette. World Neurosurg 2014; 81(1): 198-201.
[http://dx.doi.org/10.1016/j.wneu.2013.01.030] [PMID: 23314026]
[2]
Agarwal N, Tolia A, Hansberry DR, et al. Current differential diagnoses and treatment options of vascular occlusions presenting as bilateral thalamic infarcts: a review of the literature. J Neurointerv Surg 2013; 5(5): 419-25.
[http://dx.doi.org/10.1136/neurintsurg-2012-010352] [PMID: 22805281]
[3]
Alaicescu M, Nistorescu A, Popa G, et al. Anatomic, clinical and pathophysiologic correlates in acute bilateral paramedian thalamic infarcts. Rev Romana Neurol 2007; 6: 88-91.
[4]
Amin OSM, Shwani SS, Zangana HM, Hussein EM, Ameen NA. Bilateral infarction of paramedian thalami: a report of two cases of artery of Percheron occlusion and review of the literature. BMJ Case Rep 2011; 2011: bcr0920103304.
[http://dx.doi.org/10.1136/bcr.09.2010.3304] [PMID: 22715252]
[5]
Arauz A, Patiño-Rodríguez HM, Vargas-González JC, et al. Clinical spectrum of artery of Percheron infarct: clinical-radiological correlations. J Stroke Cerebrovasc Dis 2014; 23(5): 1083-8.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.09.011] [PMID: 24144596]
[6]
Aravinthan S, Muthalagan J, Murugappan M, Ponnudurai R. Bilateral thalamic infarct with neuropsychiatric manifestations. Indian J Psychiatry 2003; 45(2): 59-60.
[PMID: 21206837]
[7]
Ben S L, Jemaa H, Benammou S, Tlili-Graiess K. Occlusion of the artery of percheron: clinical and neuroimaging correlation. J Neuroradiol 2008; 35(4): 244.
[8]
Bogousslavsky J, Van Melle G, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke 1988; 19(9): 1083-92.
[http://dx.doi.org/10.1161/01.STR.19.9.1083] [PMID: 3413804]
[9]
Carrera E, Michel P, Bogousslavsky J. Anteromedian, central, and posterolateral infarcts of the thalamus: three variant types. Stroke 2004; 35(12): 2826-31.
[http://dx.doi.org/10.1161/01.STR.0000147039.49252.2f] [PMID: 15514194]
[10]
Cassourret G, Prunet B, Sbardella F, Bordes J, Maurin O, Boret H. Ischemic stroke of the artery of Percheron with normal initial MRI: a case report. Case Rep Med 2010; 2010: 425734.
[http://dx.doi.org/10.1155/2010/425734] [PMID: 20300550]
[11]
Chang YM, Fan YK. Artery of percheron occlusion in an elderly male: a case report. J Clin Med Res 2015; 7(2): 126-8.
[http://dx.doi.org/10.14740/jocmr2009w] [PMID: 25436032]
[12]
Godani M, Auci A, Torri T, Jensen S, Del Sette M. Coma with vertical gaze palsy: Relevance of angio-CT in acute percheron artery syndrome. Case Rep Neurol 2010; 2(2): 74-9.
[http://dx.doi.org/10.1159/000315835] [PMID: 20671861]
[13]
Hegde AN, Mohan S, Lath N, Lim CC. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics 2011; 31(1): 5-30.
[http://dx.doi.org/10.1148/rg.311105041] [PMID: 21257930]
[14]
Hermann DM, Siccoli M, Brugger P, et al. Evolution of neurological, neuropsychological and sleep-wake disturbances after paramedian thalamic stroke. Stroke 2008; 39(1): 62-8.
[http://dx.doi.org/10.1161/STROKEAHA.107.494955] [PMID: 18048862]
[15]
Hiratsuka Y, Kikuchi K, Miki H, Mochizuki T. Evaluation for detectability of the paramedian artery using 3D TOF MRA on 3tesla MRI. 2012.
[16]
Krampla W, Schmidbauer B, Hruby W. Ischaemic stroke of the artery of Percheron (2007: 10b). Eur Radiol 2008; 18(1): 192-4.
[http://dx.doi.org/10.1007/s00330-007-0615-0] [PMID: 18236047]
[17]
Kumral E, Evyapan D, Balkir K, Kutluhan S. Bilateral thalamic infarction. Clinical, etiological and MRI correlates. Acta Neurol Scand 2001; 103(1): 35-42.
[http://dx.doi.org/10.1034/j.1600-0404.2001.00141.x] [PMID: 11153886]
[18]
Lamot U, Popovic KS, Ribarič I, Vrabec M, Lovric D. Artery of Percheron: basic knowledge and tips on how to diagnose an ischemic infarction of this usually overlooked neurovascular variant in emergency settings. European Congress of Radiology.
[19]
Lamot U, Ribaric I, Popovic KS. Artery of Percheron infarction: review of literature with a case report. Radiol Oncol 2015; 49(2): 141-6.
[http://dx.doi.org/10.2478/raon-2014-0037] [PMID: 26029025]
[20]
Lazzaro NA, Wright B, Castillo M, et al. Artery of percheron infarction: imaging patterns and clinical spectrum. AJNR Am J Neuroradiol 2010; 31(7): 1283-9.
[http://dx.doi.org/10.3174/ajnr.A2044] [PMID: 20299438]
[21]
Linn J, Hoffmann LA, Danek A, Brückmann H. Differential diagnosis of bilateral thalamic lesions. RoFo Fortschr Geb Rontgenstr Nuklearmed 2007; 179(3): 234-45.
[http://dx.doi.org/10.1055/s-2007-962857] [PMID: 17325992]
[22]
López-Serna R, González-Carmona P, López-Martínez M. Bilateral thalamic stroke due to occlusion of the artery of Percheron in a patient with patent foramen ovale: a case report. J Med Case Reports 2009; 3(1): 7392.
[http://dx.doi.org/10.4076/1752-1947-3-7392] [PMID: 19918273]
[23]
Matheus MG, Castillo M. Imaging of acute bilateral paramedian thalamic and mesencephalic infarcts. AJNR Am J Neuroradiol 2003; 24(10): 2005-8.
[PMID: 14625223]
[24]
Mutarelli EG, Omuro AM, Adoni T. Hypersexuality following bilateral thalamic infarction: case report. Arq Neuropsiquiatr 2006; 64(1): 146-8.
[http://dx.doi.org/10.1590/S0004-282X2006000100032] [PMID: 16622574]
[25]
Percheron G. Arteries of the human thalamus. II. Arteries and paramedian thalamic territory of the communicating basilar artery. Rev Neurol (Paris) 1976; 132(5): 309-24.
[PMID: 959702]
[26]
Perren F, Clarke S, Bogousslavsky J. The syndrome of combined polar and paramedian thalamic infarction. Arch Neurol 2005; 62(8): 1212-6.
[http://dx.doi.org/10.1001/archneur.62.8.1212] [PMID: 16087760]
[27]
Schmahmann JD. Vascular syndromes of the thalamus. Stroke 2003; 34(9): 2264-78.
[http://dx.doi.org/10.1161/01.STR.0000087786.38997.9E] [PMID: 12933968]
[28]
Shea YF, Lin OY, Chang RS, Luk JK. Artery of percheron infarction. Hong Kong Med J 2012; 18(5): 446.e1-2.
[PMID: 23018077]
[29]
Smith AB, Smirniotopoulos JG, Rushing EJ, Goldstein SJ. Bilateral thalamic lesions. AJR Am J Roentgenol 2009; 192(2): W53-62.
[http://dx.doi.org/10.2214/AJR.08.1585] [PMID: 19155381]
[30]
Teoh HL, Ahmad A, Yeo LL, Hsu E, Chan BP, Sharma VK. Bilateral thalamic infarctions due to occlusion of artery of percheron. J Neurol Sci 2010; 293(1-2): 110-1.
[http://dx.doi.org/10.1016/j.jns.2010.03.031] [PMID: 20417939]

Rights & Permissions Print Cite
Article Metrics
47
1
Wayfinder Image
Open Access Journals Promotions
© 2024 Bentham Science Publishers | Privacy Policy