Authors : Andres Felipe Ospina Cifuentes; Rafael David Moreno Ruiz; Cristian Rodrigo Hernández Pérez; Jhoan David Maldonado Bonilla; Pablo Alejandro Lopez Mejia

Volume/Issue : Volume 10 - 2025, Issue 1 - January

Google Scholar : https://tinyurl.com/ydkukbs2

Scribd : https://tinyurl.com/294kbsk5

DOI : https://doi.org/10.5281/zenodo.14848295

Abstract : A stroke involving the artery of Percheron is an infrequent condition arising from an anatomical variant in the vascular supply of the thalamus and midbrain. This particular vascular configuration can lead to bilateral thalamic infarctions, characterized by significant neurological impairment, including altered consciousness, cognitive deficits, and motor dysfunction. Identifying this pathology is challenging due to its atypical clinical presentation. This case report describes a wake-up ischemic stroke associated with the artery of Percheron. Its purpose is to analyze the diagnostic challenges, therapeutic interventions, and management strategies employed in the emergency department setting, highlighting the educational and clinical implications that such events contribute to the medical literature.

Keywords : Percheron Artery, Wake-Up Stroke, Bilateral Thalamus Infarcts.

References :

1. Ciacciarelli A, Francalanza I, Giammello F, Galletta K, Toscano A, Musolino RF, et al. Prevalence, clinical features, and radiological pattern of artery of Percheron infarction: a challenging diagnosis. Neurological Sciences. 2023 Jul 1;44(7):2413–9.
2. Matheus MG, Castillo M. Imaging of Acute Bilateral Paramedian Thalamic and Mesencephalic Infarcts Case Report. Vol. 24, AJNR Am J Neuroradiol. 2005.
3. 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 May;2(2):74–9.
4. 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.
5. Li S, Kumar Y, Gupta N, Abdelbaki A, Sahwney H, Kumar A, et al. Clinical and Neuroimaging Findings in Thalamic Territory Infarctions: A Review. Vol. 28, Journal of Neuroimaging. Blackwell Publishing Inc.; 2018. p. 343–9.
6. Kichloo A, Jamal SM, Zain EA, Wani F, Vipparala N. Artery of Percheron Infarction: A Short Review. J Investig Med High Impact Case Rep. 2019 Aug 1;7.
7. Zhang YL, Zhang JF, Wang XX, Wang Y, Anderson CS, Wu YC. Wake-up stroke: imaging-based diagnosis and recanalization therapy. Vol. 268, Journal of Neurology. Springer Science and Business Media Deutschland GmbH; 2021. p. 4002–12.
8. Zhang B, Wang X, Gang C, Wang J. Acute percheron infarction: a precision learning. BMC Neurol. 2022 Dec 1;22(1).
9. Manawadu D, Bodla S, Jarosz J, Keep J, Kalra L. A case-controlled comparison of thrombolysis outcomes between wake-up and known time of onset ischemic stroke patients. Stroke. 2013 Aug;44(8):2226–31.
10. Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B, et al. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. New England Journal of Medicine. 2018 Aug 16;379(7):611–22.
11. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018 Mar 1;49(3):e46–110.