Infarction due to occlusion of the artery of Percheron

Abstract

Background: Percheron artery infarction is an acute bilateral thalamic disease, occurring in 0.1%-0.3% of all ischemic strokes; The diagnosis is confirmed by magnetic resonance imaging and Angio-tomography. Clinical case: 74-year-old male, with a history of diabetes mellitus, arterial hypertension and dyslipidemia, with a two-day history of disorientation, incoherent speech, bradylalia, dysarthria, difficulty swallowing and altered consciousness. On physical examination: blood pressure 160/90 mmHg, Neurological Glasgow 11/15, limitation of vertical gaze, absence of gag reflex and difficulty swallowing, without alterations in mobilization. Axial computed tomography of the brain: diffuse bi-hemispheric cerebral atrophy, areas of hypodensity of the bilateral periventricular white matter with extension to the corona radiata, hypodensity in the paramedial aspect of both thalami with a density of +32 HU in the territory of the artery of Percheron. C-Reactive Protein with a tendency to increase (30.7, 97.4, r: 1-5). Doppler ultrasound of the neck identifies carotid atherosclerotic changes with complex bilateral thickening of the intima media in the common carotid with extension to bulbs, unstable narrowing of 50% due to posterior wall plaque in the left carotid bulb. Conclusion: This report shows that promptness in performing simple brain computed tomography in a low-resource environment can be useful for the approach to patients with a suspected diagnosis of Percheron Syndrome.