Artery of Percheron Infarction Presenting As Altered Consciousness in an Elderly Patient: A Case Report

Bilateral thalamic infarcts represent an uncommon manifestation of acute ischemic stroke, often resulting from occlusion of the artery of Percheron (AOP). Thereby, we report the case of an 86-year-old female with a background of multiple comorbidities who presented with sudden-onset unresponsiveness. Her Glasgow coma scale (GCS) score on admission was 10/15. Non-contrast computed tomography (NCCT) of the head ruled out intracranial hemorrhage. While being empirically managed for a suspected meningitis, the patient's admission was complicated by a marked reduction in her GCS (5/15) along with new-onset left-sided facial weakness and ptosis. On admission day 6, a diffusion-weighted magnetic resonance imaging sequence (DWI-MRI) revealed acute ischemic changes in the midbrain and bilateral thalami, which were consistent with the occlusion of AOP. The patient deteriorated very quickly and passed away during the same admission. This case illustrates the elusive clinical presentation of AOP infarction and underscores the urgent need for adequate neuroimaging to avoid any unwarranted medical treatment.