Artery of Percheron: an unusual stroke presentation

Area of Science:

• Neurology
• Vascular Neurology
• Neuroimaging

Background:

• Artery of Percheron (AOP) infarction is a rare cerebrovascular event affecting the medial thalamic territory.
• Diagnosis can be challenging due to non-specific and variable neurological presentations, often leading to delayed recognition.
• Initial neuroimaging, including CT and sometimes MRI, may not reveal acute findings, further complicating diagnosis.

Observation:

• An 86-year-old female presented with recurrent transient loss of consciousness, initially misdiagnosed as seizures.
• Subsequent MRI revealed acute bilateral medial thalamic infarcts, consistent with the Artery of Percheron (AOP) territory.
• The patient was diagnosed with JAK2-positive myeloproliferative neoplasm, a potential underlying cause for thrombocytosis.

Findings:

• This case represents the first reported instance of Artery of Percheron (AOP) infarction presenting with transient symptoms mimicking seizure activity.
• The diagnostic delay underscores the need for a broad differential diagnosis in patients with unexplained transient neurological events.
• Advanced neuroimaging techniques are crucial for identifying AOP infarcts, particularly when initial assessments are inconclusive.

Implications:

• Increased awareness of AOP infarction's varied presentation is essential for timely diagnosis and appropriate management.
• A multi-modality imaging approach and consideration of underlying hematological conditions are vital in complex neurological cases.
• This case expands the understanding of AOP infarction's clinical spectrum and diagnostic challenges in cerebrovascular disease.