Artery of Percheron infarction with persistent amnesia: a case report of bilateral paramedian thalamic syndrome
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CASE REPORT
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Artery of Percheron infarction with persistent amnesia: a case report of bilateral paramedian thalamic syndrome Hannah E. Snyder1, Sheliza Ali2,3, Joanna Sue2,4, Ayse Unsal2,4, Crystal Fong5 and Zhihui Deng2,6*
Abstract Background: The artery of Percheron is an uncommon anatomic variant which supplies the bilateral paramedian thalami and rostral midbrain. While infarction of its vascular territory can result in a wide range of symptoms, paramedian thalamic syndrome is classically described as a triad of symptoms including vertical gaze disturbances, fluctuating level of consciousness, and amnesia. There is minimal evidence to date to characterize the long-term cognitive consequences of infarction of the artery of Percheron utilizing neuropsychological assessment. Case presentation: We describe a 40-year-old female patient initially presenting with dizziness, confusion and falls with unremarkable head CT scans. Subsequent MRI, more than 24 h after symptom onset, identified evidence of bilateral thalamic and rostral midbrain infarction. Neuropsychological testing was administered at 4 months poststroke, with follow up testing at 1 year. The patient was found to have profound anterograde and retrograde amnesia, which did not change significantly over the first year of rehabilitation, and which was not easily identifiable in everyday encounters due to her relatively intact working memory and social skills. Conclusions: As early diagnosis of infarction of the artery of Percheron is challenging, patients have frequently missed the time window for acute management of ischemic stroke. Moreover, this case study highlights the need for further research in deciphering the role of the paramedian thalamus in memory and cognition, as well as the importance of standardized neuropsychological testing for the artery of Percheron stroke patients to identify safety and rehabilitation concerns that may be overlooked. Keywords: Artery of Percheron, Paramedian thalamus, Neuropsychological assessment, Anterograde and retrograde amnesia
Background The artery of Percheron (AOP) is an uncommon anatomic variant first described by Gérard Percheron in 1973. It refers to a single arterial trunk originating from one of the proximal posterior cerebral arteries to supply bilateral paramedian thalami and rostral midbrain [1]. The AOP is thought to occur in up to 33% of the * Correspondence: [email protected] 2 Regional Rehabilitation Centre, Hamilton Health Sciences, Hamilton, Canada 6 Division of Physical Medicine and Rehabilitation, Department of Medicine, McMaster University, Hamilton, Canada Full list of author information is available at the end of the article
population, with a majority of individuals having independent hemispheric vascularization of these structures [2]. Infarction of this artery is often characterized by a triad of symptoms including altered level of consciousness, memory deficits, and supranuclear and vertical gaze palsies [3]. Rarer clinical presentations have been described, including patie
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