Background And Purpose: The Artery of Percheron (AoP) supplying bilateral paramedian thalami and rostral midbrain is a rare anatomical variant. In the event of occlusion of AoP, a characteristic pattern of ischaemia is seen, presenting as bithalamic signal abnormality on magnetic resonance imaging (MRI). However, this particular imaging finding has significant radiological and clinical overlap with other conditions, necessitating a comprehensive understanding of the imaging characteristics and potential differential diagnosis. The aim of this pictorial essay is to provide a visual documentation of varying appearances of AoP infarction on imaging and highlighting other important pathologies that may cause similar appearance.
Methods: Retrospective collection and review of imaging from patients with confirmed AoP infarction and other pathologies causing bithalamic signal abnormalities and identify crucial imaging caveats for differentiation.
Results: We present a comprehensive visual spectrum of AoP infarction patterns, including bithalamic involvement (paramedian thalamic lesions) with or without midbrain involvement. Additionally, the "V" sign, observed on FLAIR and DWI sequences, is fairly characteristic of AoP infarction. Other important vascular causes seen include top of basilar artery syndrome, internal cerebral vein thrombosis as well as neoplastic lesions including diffuse midline glioma (DMG) H3 K27-altered. Additionally various inflammatory, metabolic and infective etiologies including viral encephalitis like Japanese encephalitis can cause a similar appearance.
Conclusions: This pictorial essay demonstrates the diverse patterns of AoP infarction and emphasizes the significance of recognizing important mimics of this condition, highlighting the need for a meticulous evaluation. Improved awareness and understanding of these imaging characteristics will contribute to more effective management of patients with thalamic strokes.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1007/s00234-025-03585-2 | DOI Listing |
Neuroradiology
March 2025
East Sussex Healthcare NHS Trust, Saint Leonards-on-Sea, UK.
Background And Purpose: The Artery of Percheron (AoP) supplying bilateral paramedian thalami and rostral midbrain is a rare anatomical variant. In the event of occlusion of AoP, a characteristic pattern of ischaemia is seen, presenting as bithalamic signal abnormality on magnetic resonance imaging (MRI). However, this particular imaging finding has significant radiological and clinical overlap with other conditions, necessitating a comprehensive understanding of the imaging characteristics and potential differential diagnosis.
View Article and Find Full Text PDFCureus
February 2025
General Practice, Royal Cornwall Hospital, Cornwall, GBR.
Artery of Percheron (AOP) infarction is a rare but clinically important cause of unilateral or bilateral thalamic infarction, commonly with a heterogeneous presentation and nonspecific neurological symptoms. In contrast to unilateral thalamic strokes, AOP infarction can present a unique hurdle for diagnostic considerations owing to its atypical clinical manifestation and the lack of widespread knowledge of this anatomic variant among clinicians. AOP infarction is associated with potentially better outcomes if it is diagnosed early, as timely and appropriate interventions can greatly affect the outcome.
View Article and Find Full Text PDFCureus
January 2025
Department of Neurology, Hassan II University Teaching Hospital, Fez, MAR.
The artery of Percheron (AOP) is a rare vascular variant that can cause bilateral paramedian thalamic infarctions when occluded. Due to its atypical clinical presentation and subtle imaging findings, this condition often leads to significant diagnostic challenges. The timely recognition of this condition is critical to implementing appropriate management strategies and improving patient outcomes.
View Article and Find Full Text PDFMed Klin Intensivmed Notfmed
January 2025
Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Deutschland.
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 PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!