Brain MRI findings in Percheron syndrome. A clinical case report

Abstract

Introduction: Percheron syndrome (PS) or bilateral thalamic infarction, is a rare entity that represents 0.1 % of total ischemic strokes with a prevalence that is estimated to be between 4% to11.7 % in the general population. PS has a variable clinical features and sometimes results in a diagnostic challenge, due to the variability of the vascular anatomy of the vessels that supply the thalamus and the cerebral territories that can be affected in case of ischemia; the objectives of this article are to present a clinical case of PS in a comorbid patient whose diagnosis was achieved by
brain magnetic resonance imaging (MRI); describe the clinical approach and imaging findings of this entity and emphasize some key aspects of the thalamic blood supply for the proper diagnosis and classification of PS on MRI. Materials and methods: The clinical case of a 60-year-old patient with multiple cardiovascular diseases and recent coronary revascularization who had a sudden deterioration in the state of consciousness with oculomotor alterations is reported. The brain MRI revealed an acute infarction with signs of hemorrhagic transformation in bilateral central medial thalamic and bilateral paramedian region of the midbrain in the territory of the Percheron artery (PA). The patient required invasive ventilatory assistance with subsequent removal and partial improvement of his neurological condition. Outcomes and conclusions: MRI is the study of choice in cases of suspected PS due to its high specificity and early diagnostic capacity. PA infarction
presents as an abnormal signal intensity on MRI and its main causes include small vessel disease and cardioembolism, being more prevalent in men with a mean age of presentation of 60 years and related to cardiovascular risk factors.