Stroke involving the percheron artery: a rare anatomical var
Artery of Percheron is a rare anatomical variant of posterior cerebral circulation. Stroke involving this artery causes characteristic bilateral thalamic infarcts. The following case has been reported in the Journal of Neurology Research.

A 53-year-old male, with a past medical history of diabetes mellitus and hypertension, presented to the emergency department (ER) with the chief complaint of “right leg weakness and difficulty walking” since the last 8 h. The patient worked in a transportation company and he was pushing a wheelchair when he noticed that he was dragging his right leg. Then when signing the patient’s arrival in his transport, he had trouble in signing. When he was sent to the hospital, he developed tingling and numbness of right hand.

On arrival to ER, vital signs were: blood pressure (BP) of 190/85 mm Hg, pulse of 89/min, respiratory rate of 20/min and temperature of 97.7 °F. On neurological examination, power was 3/5 in the right leg and right arm. Sensations to pinprick were decreased on the right arm. The rest of examination was within normal limits. Initial lab work showed white blood cell (WBC) count of 5.9 × 103/mL, hemoglobin of 14 g/dL, hematocrit of 42.4%, platelets of 164 k/µL, blood urea nitrogen (BUN) of 8 mg/dL, creatinine of 1 mg/dL, glucose of 305 mg/dL, sodium of 136 mmol/L and potassium 3.8 mmol/L.

Code stroke was called and a head CT scan was done that was negative for any bleed or ischemia. The patient was admitted to the stroke unit and the next day, the MRI of the brain showed bilateral thalamic infarcts.

The characteristic infarct pattern prompted a need for CT angiography (CTA) of head and neck which was negative for any large-vessel occlusion, any high-grade stenosis or any aneurysm, but revealed a filling defect in the artery of Percheron suggestive of occlusion.

He was started on non-tissue plasminogen activator (tPA) protocol for stroke treatment as he was out of window for tPA. Aspirin and statin along with physical therapy were started and over the next few days, patient’s neurological symptoms improved and he was discharged home.

Learning Points:-
• The present case highlights the importance of raising our awareness about the artery of Percheron and the prompt recognition of its infarction by pursuing appropriate imaging studies to allow timely administration of thrombolysis.

• Reversal of a potential damaging neurological insult and subsequent favorable clinical improvement are the expected outcomes.

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