EC Neurology

Case Series Volume 16 Issue 8 - 2024

Imaging of Bilateral Thalamic Infarcts (Percheron Territory) and Differential Diagnosis (About Six Cases)

Asmae Rais1*, Fatima Saddouki1, Nizar El Bouardi1, Amal Akammar1, Meriem Haloua1, Badreddine Alami1, Aouatef El Midaoui2, Siham Bouchal2, Mohammed Faouzi Belahsen2, Meryem Boubbou1, Mustapha Maaroufi1 and Moulay Youssef Alaoui Lamrani1

1Department of Radiology, CHU Hassan II, Sidi Mohammed Benabdellah University Faculty of Medicine and Pharmacy of Fez, Morocco 2Department of Neurology, CHU Hassan II, Sidi Mohammed Benabdellah University Faculty of Medicine and Pharmacy of Fez, Morocco

*Corresponding Author: Asmae Rais, Department of Radiology, CHU Hassan II, Sidi Mohammed Benabdellah University Faculty of Medicine and Pharmacy of Fez, Morocco.
Received: July 17, 2024; Published: August 20, 2024



The artery of Percheron is a rare anatomic variant of the paramedian (or thalamo-perforating) artery that represents a solitary trunk which provides bilateral arterial supply to the rostral midbrain and paramedian thalamus. The complex anatomy causes a large clinical variability which makes the clinical diagnosis of Percheron occlusion very difficult and often delayed and made outside the window of thrombolytic treatment for ischemic stroke. It is characterized in imaging with a paramedian bithalamic infarcts, that can be associated to a mesencephalic infarction. Even though the usual imaging results are habitually acknowledged, only a limited number of case series and case reports of artery of Percheron infarction have been disclosed. We report a series of six cases that presented with bilateral thalamic infarcts. The objective of this study is to illustrate the thorough and precise imaging spectrum of artery of Percheron infarction and its wide differential diagnosis.

 Keywords: Artery of Percheron; Thalamus; Infarction; Imaging; Magnetic Resonance Imaging

  1. Cassourret G., et al. “Ischemic stroke of the artery of Percheron with normal initial MRI: a case report”. Case Reports in Medicine (2010): 425734.
  2. Musa J., et al. “Artery of Percheron infarction: a case report and literature review”. Radiology Case Reports6 (2021): 1271-1275.
  3. Li J., et al. “Clinical review and analysis of artery of Percheron infarction”. IBRO Neuroscience Reports 15 (2023): 17-23.
  4. Lazzaro NA., et al. “Artery of Percheron infarction: imaging patterns and clinical spectrum”. American Journal of Neuroradiology 7 (2010): 1283-1289.
  5. Krampla W., et al. “Ischaemic stroke of the artery of Percheron (2007: 10b)”. European Radiology1 (2008): 192-194.
  6. Zhang B., et al. “Acute Percheron infarction: a precision learning”. BMC Neurology1 (2022): 207.
  7. Lamboley JL., et al. “Occlusion de l’artère de Percheron: difficultés du diagnostic clinique et place de l’IRM. À propos de six cas”. Journal de Radiologie 12 (2011): 1113-1121.
  8. Lahnine G., et al. “Bilateral thalamic infarcts: Percheron territory”. Radiology Case Reports4 (2024): 1344-1350.
  9. Partlow GD., et al. “Bilateral thalamic glioma: review of eight cases with personality change and mental deterioration”. American Journal of Neuroradiology 4 (1992): 1225-1230.
  10. Smith AB., et al. “Bilateral thalamic lesions”. American Journal of Roentgenology 2 (2009): W53-W62.
  11. Al-Okaili RN., et al. “Advanced MR imaging techniques in the diagnosis of intraaxial brain tumors in adults”. Radiographics 1 (2006): S173-S189.
  12. Mangla R., et al. “Percentage signal recovery derived from MR dynamic susceptibility contrast imaging is useful to differentiate common enhancing malignant lesions of the brain”. American Journal of Neuroradiology6 (2011): 1004-1010.
  13. Tuttle C., et al. “Neuroimaging of acute and chronic unilateral and bilateral thalamic lesions”. Insights into Imaging 10 (2019): 24.
  14. Dietemann JL., et al. “Imaging in acute toxic encephalopathy”. Journal of Neuroradiology= Journal de Neuroradiologie4 (2004): 313-326.
  15. Garg P., et al. “Osmotic demyelination syndrome-evolution of extrapontine before pontine myelinolysis on magnetic resonance imaging”. Journal of Neurosciences in Rural Practice1 (2019): 126-135.
  16. Yoshikawa T., et al. “Diffusion-weighted magnetic resonance imaging of dural sinus thrombosis”. Neuroradiology6 (2002): 481-488.
  17. Kamtchum Tatuene J., et al. “Illustrating the relevance of updated diagnostic criteria for sporadic Creutzfeldt-Jakob disease: a teaching neurocase”. BMJ Case Reports (2013): bcr2013010061.
  18. Lövblad KO., et al. “The fornix and limbic system”. Seminars in Ultrasound, CT and MRI 5 (2014): 459-473.
  19. Wong AM., et al. “Acute necrotizing encephalopathy of childhood: correlation of MR findings and clinical outcome”. American Journal of Neuroradiology9 (2006): 1919-1923.

Asmae Rais., et al. “Imaging of Bilateral Thalamic Infarcts (Percheron Territory) and Differential Diagnosis (About Six Cases)”. EC Neurology  16.8 (2024): 01-13.