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Prevalence, clinical features, and radiological pattern of artery of Percheron infarction: a challenging diagnosis

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Abstract

Purpose

Occlusion of artery of Percheron (AOP), a rare variant of paramedian branches of posterior cerebral artery, results in a characteristic pattern of ischemic lesions in bilateral paramedian thalami with or without midbrain and anterior thalami involvement.

Aim

To evaluate the prevalence, the clinical, and the imaging features of AOP infarction in a single comprehensive stroke center experience.

Methods

We retrospectively search in our stroke center database, patients with ischemic lesions in the AOP distribution. We collected clinical features and time between hospital admission and diagnosis. Imaging findings were categorized following a pre-selected classification.

Results

Of 2830 ischemic stroke admitted in our center, we identified 15 patients with AOP infarction (0.53%). Clinical manifestations were variable, but oculomotor disturbances, particularly vertical gaze palsy, were the most observed, followed by consciousness impairment, varying from drowsiness to coma. The most frequent imaging pattern was bilateral paramedian thalamic infarction with midbrain infarction, and the V-sign was recognized in 6 cases from this group. In 8 patients a fetal origin of the PCA was observed. The average time from first hospital admission to diagnosis was 28.09 h.

Conclusions

The prevalence of AOP infarction in our center was 0.53%. Diagnosis of AOP infarction can be challenging and should be suspected in case of sudden altered consciousness.

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Data Availability

Anonymized data not published within this article will be made available by request from any qualified investigator.

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Acknowledgements

We thank the patients and the patients’ family for their kind cooperation. We would like to thank all professionals involved in stroke care during the pandemic.

Author information

Authors and Affiliations

  1. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Antonio Ciacciarelli, Isabella Francalanza & Fabrizio Giammello

  2. International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy

    Fabrizio Giammello, Antonio Toscano, Rosa Fortunata Musolino & Paolino La Spina

  3. Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy

    Karol Galletta & Francesca Granata

Authors
  1. Antonio Ciacciarelli
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Contributions

A.C., I.F, and F.Gi. contributed to the study design. I.F., and A.C. performed data collections. K.G., and F.Gr. performed imaging analysis. I.F., A.C., and F.Gi. wrote the article. F.Gr. reviewed and critiqued the manuscript. A.To., R.F.M., and P.L.S supervised the research.

Corresponding author

Correspondence to Fabrizio Giammello.

Ethics declarations

Ethics approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The paper does not report on primary research. Our analysis looked retrospectively at outcomes for a large cohort of patients treated. All data analyzed were collected as part of routine diagnosis and treatment.

Consent to participate

Informed consent was waived given to the retrospective anonymous collection of data, according to Italian regulations.

Consent for publication

Informed consent was waived given to the retrospective anonymous collection of data, according to Italian regulations.

Conflict of interest

The authors declare no competing interests.

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Publisher's note

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Antonio Ciacciarelli, Isabella Francalanza, and Fabrizio Giammello contributed equally to this work and should be considered co-first authors.

Francesca Granata and Paolino La Spina contributed equally to this work and should be considered co-last authors.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary figure 1.

Electroencephalography of patient n. 11 (see main text). (PNG 151 kb)

High resolution image (TIF 277 kb)

Supplementary figure 2.

Electroencephalography of patient n. 8 (see main text). (PNG 166 kb)

High resolution image (TIF 294 kb)

Supplementary figure 3.

Correlation analysis and linear regression analysis of vomuletric measurement of thalamic lesion with NIHSS and GCS. The infarct volume correlates significantly with NIHSS on admission. The linear regression analysis showed a tendency to relate with higher NIHSS and lower GCS, considering both admission and discharge estimation. (PNG 43 kb)

High resolution image (TIF 67 kb)

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Ciacciarelli, A., Francalanza, I., Giammello, F. et al. Prevalence, clinical features, and radiological pattern of artery of Percheron infarction: a challenging diagnosis. Neurol Sci 44, 2413–2419 (2023). https://doi.org/10.1007/s10072-023-06681-4

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  • DOI: https://doi.org/10.1007/s10072-023-06681-4

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