Samia Amar, Boutaina Essaher, Yahya Sqalli Houssaini, Asmaa Fariyou, Hassan Ennouali, Mohammed Ennmer
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 8
Date of Publication: 2026/08/26
Artery of Percheron (AOP) infarction is an uncommon cause of bilateral paramedian thalamic ischemia and may present with nonspecific neurological manifestations that delay recognition of acute stroke. We report the case of a 76-year-old man with treated arterial hypertension and diabetes mellitus who presented with acute impairment of consciousness and was admitted approximately 3 hours after symptom onset. Brain magnetic resonance imaging (MRI) demonstrated bilateral paramedian thalamic diffusion restriction with corresponding low apparent diffusion coefficient (ADC) values and FLAIR hyperintensity, consistent with acute ischemic infarction. No mesencephalic involvement was observed. Three-dimensional time-of-flight (3D TOF) magnetic resonance angiography showed no proximal intracranial arterial occlusion; the AOP was not visualized. The characteristic bilateral paramedian thalamic distribution, together with the clinical presentation, supported the diagnosis of AOP territory infarction. The patient received intravenous thrombolysis within the therapeutic window. This case highlights the importance of recognizing the characteristic MRI pattern of AOP infarction in patients presenting with otherwise unexplained acute impairment of consciousness, even in the absence of midbrain involvement or direct visualization of the responsible perforating artery.
Artery of Percheron, Bilateral thalamic infarction, Ischemic stroke, Impaired consciousness
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