Percheron artery occlusion and recanalization after intravenous thrombolysis

Abstract

Background— The infarct of the bilateral paramedian thalamus and midbrain due to the occlusion of the artery
of Percheron is an atypical clinical presentation of acute stroke. It consists in the triad of altered vigilance status,
memory disturbances and vertical gaze palsy. In the absence of classical lateralized neurological deficits, it is difficult
to achieve the diagnosis and to timely treat this condition by intravenous thrombolysis.
Case Description—Here we report the case of a 55-year-old who presented the acute onset of vigilance
disturbances, oculomotor alteration and left-sided hemiparesis from a bilateral thalamic infarction and occluded
artery of Percheron. After intravenous thrombolysis administered within 2 hours from stroke onset, the patient had
full clinical recovery within 24 hours, and follow-up imaging showed recanalization of the artery of Percheron.
Conclusion— This case report provides the first radiological description of an acute occlusion of the artery of
Percheron and its complete recanalization after intravenous thrombolysis on follow-up imaging. In our patient, this
prompt diagnosis, treatment, and recanalization led to a rapid and full neurological recovery.