Sabry Safan Abeer, Eltazi Isra, Zammar Khaled, Hussain Suhail, Muhammad Ahmad, Haroon Khawaja, Mahmoud Mostafa, Koç Osman
Department of Neurology, Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar.
Department of Interventional Radiology, Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar*Correspondence: Abeer Sabry Safan. Email:
Qatar Med J. 2025 Mar 18;2025(1):29. doi: 10.5339/qmj.2025.29. eCollection 2025.
The artery of Percheron (AOP) stroke is a rare cause of bilateral thalamic strokes, which may or may not involve the midbrain. Existing literature has identified four anatomical variants of thalamic blood supply, with AOP being the IIB variant that arises as a solitary arterial trunk from either posterior communicating artery. The clinical manifestations of AOP strokes are diverse, with no specific localizing signs. Typically, patients present with symptoms such as amnesia, gaze palsy, and hypersomnolence. The predominant underlying etiology is often cardioembolic, requiring management strategies that are tailored to the source of emboli with anticoagulation/antiplatelets.
We report a case involving a 72-year-old female patient with AOP stroke characterized by a sudden loss of vision, followed by a decreased level of consciousness. Magnetic resonance imaging revealed bilateral thalamic infarcts sparing the midbrain. CTA (computed tomography angiography) revealed a filling defect at the origin of the Percheron artery arising from the left P1 segment. The patient was treated with intravenous thrombolysis. The stroke workup was unremarkable, with a normal thrombophilia workup, a transthoracic echo, and no arrhythmias detected on a prolonged Holter monitor. The patient was treated with aspirin, atorvastatin, and intensive physical and cognitive therapy. On follow-up, she regained her consciousness but exhibited residual impaired vertical eye movements and right-sided dysmetria.
AOP stroke is a radiological diagnosis with no specific localizing neurological signs. A high index of suspicion is essential for timely diagnosis and management, as bilateral thalamic involvement can arise from a wide range of metabolic, infectious, and other vascular etiologies that could delay optimal management.
佩谢隆动脉（AOP）卒中是双侧丘脑卒中的罕见病因，可能累及中脑，也可能不累及。现有文献已确定丘脑血液供应的四种解剖变异，AOP为IIB型变异，它作为单一动脉干起源于后交通动脉。AOP卒中的临床表现多样，无特异性定位体征。典型表现为失忆、凝视麻痹和嗜睡等症状。主要潜在病因通常是心源性栓塞，需要根据栓子来源采用抗凝/抗血小板药物进行针对性治疗。
我们报告一例72岁女性AOP卒中患者，其特征为突发视力丧失，随后意识水平下降。磁共振成像显示双侧丘脑梗死，中脑未受累。CTA（计算机断层血管造影）显示起源于左侧P1段的佩谢隆动脉起始处有充盈缺损。患者接受了静脉溶栓治疗。卒中检查无异常，血栓形成倾向检查、经胸超声心动图均正常，动态心电图监测未发现心律失常。患者接受了阿司匹林、阿托伐他汀治疗以及强化的物理和认知治疗。随访时，她恢复了意识，但仍存在垂直眼球运动残留障碍和右侧辨距不良。
AOP卒中是一种无特异性定位神经体征的影像学诊断。高度怀疑对于及时诊断和治疗至关重要，因为双侧丘脑受累可能由多种代谢、感染和其他血管病因引起，可能会延误最佳治疗。
