The posterior communicating artery (PcomA), P1 and P2 segments of the posterior cerebral arteries (PCAs) give rise to numerous small branches that chiefly supply the thalamus and midbrain. Thalamic vascular supply is classically categorized into four regions: anterior, paramedian, infero-lateral and posterior. Despite significant variations and overlap in the blood supply, this traditional classification helps in understanding the vascular anatomy of the thalamus. Gerard Percheron extensively studied thalamic blood supply and described its anatomical variants depending on its origin. The artery of Percheron (AOP) is a rare anatomical variation of paramedian-mesencephalic arterial supply in which a solitary arterial trunk arises from the PCA and distributes bilaterally to both paramedian thalami and often to the rostral part of the midbrain. During routine dissection of the brain of a 46-year-old female in the department of anatomy, it was seen that thalamo-perforating artery (AOP) took origin as a single trunk from the P1 segment of the left PCA. The specimen was dissected and photographed for documentation and to see more details. The exact prevalence of AOP remains unknown, but various studies show that it can be present in 7% to 11.7% of subjects. Detailed knowledge of AOP anatomical variation is crucial for interpreting neuroimaging results or performing different neuro-endovascular techniques at the basilar bifurcation, particularly in patients with bilateral thalamic and midbrain infarctions.
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http://dx.doi.org/10.7759/cureus.57266 | DOI Listing |
Cureus
November 2024
Neurology, Dalhousie University, Halifax, CAN.
This case report discusses a unique presentation of an artery of Percheron (AOP) infarct resulting in rapidly resolving internuclear ophthalmoplegia (INO) without classical signs. This is the case of a 70-year-old male patient who presented to a community Emergency Department following acute code stroke activation. Physical exam and imaging studies including non-contrast CT, CT angiography, CT perfusion, and MRI were performed.
View Article and Find Full Text PDFMedicine (Baltimore)
December 2024
Department of Neurology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China.
Rationale: Bilateral thalamic infarction is a rare type of posterior circulation stroke, and it often presents with a reduced level of consciousness in the elderly. Arteriosclerosis is the primary etiology of bilateral thalamic infarction, including conditions such as native vessel stenosis or arterial-to-arterial embolism. Cardiogenic or paradoxical embolism can also lead to thrombosis of the perforator branches innervating the thalamus, and these emboli tend to disintegrate and lead to multiple lesions, even in elderly patients.
View Article and Find Full Text PDFNeurocase
October 2024
Faculté de médecine et de pharmacie de Casablanca, Université Hassan II de Casablanca, Casablanca, MA, Morocco.
J Nippon Med Sch
November 2024
Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital.
The artery of Percheron (AOP), a common anatomic vascular variation of the P1 segment of the posterior cerebral artery, provides arterial blood supply to the paramedian thalami and rostral midbrain. Occlusion of the AOP can lead to infarction of the bilateral paramedian thalamus, with or without midbrain involvement, but is rare in children. Here, we describe a case involving a 14-year-old girl with sudden onset of disturbance of consciousness, hypersomnia, and global aphasia.
View Article and Find Full Text PDFCureus
September 2024
Department of Neurology, Jose R. Reyes Memorial Medical Center, Manila, PHL.
Occlusion of the artery of Percheron (AOP) is a rare yet potentially disabling form of ischemic stroke resulting in infarction of the bilateral paramedian thalami and mesencephalon with variable and often atypical presentation. Given the various patterns of thalamic blood supply, recognizing the presence of AOP infarction is crucial for the diagnosis and management of ischemic strokes involving these regions. Here, we report a case of acute hemorrhagic infarction involving the bilateral thalami and the rostral mesencephalon caused by a cardioembolic occlusion of the AOP.
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