Abstract Details

Title Artery of Percheron Infarct: A difficult diagnosis in the emergency room. Report of 7 cases in Argentina

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-050

Objective To describe the clinical characteristics of 7 patients with an AP infarct.

Background The paramedian territory of the thalamus is usually supplied by thalamoperforating arteries, which arise from the posterior cerebral artery (PCA). The artery of Percheron (AP) is an uncommon anatomic variant in which a single dominant thalamoperforating artery supplies both medial thalami. Its occlusion results in a rare but characteristic pattern of ischemia: bilateral paramedian thalamic infarcts (0,1% of all strokes). Its unusual presentation produces diagnostic and therapeutic delays. Experience on the management of this pathology is limited to small series or isolated cases.

Design/Methods Multicentric observational descriptive study.

Results We evaluated 7 patients ( 4 males, mean age: 70.57 (60-85) years). Past medical history: 85,71% hypertension, 42,85% hyperlipidemia, 28,57% previous stroke and 14,28% diabetes mellitus. Mean NIHSS on admission: 10 points (2-19). All patients presented obtundation or coma (2 cases required orotracheal intubation), associated with: diplopia (3), aphasia (3), motor deficits (3) and psychomotor agitation at onset (1). The delay of diagnosis was: in 2 patients < 3 hours, in 4 patients a mean of 6.75 days (2 initially interpreted as encephalitis/drug intoxication) and in 1 was 13 months (initial interpretation: tumor). Only 2 patients received intravenous thrombolytics: their admission NIHSS were 14 and 9 points and both patients returned home without sequelae. The average discharge NIHSS was 5 points (0-11) in 6 patients and unknown in 1.

Conclusions Patients with AP infarctions present with obtundation, agitation or coma. The absence of focal symptoms in most patients makes diagnosis difficult. Early identification is essential to establish reperfusion therapies. Two of our patients received intravenous thrombolytic with excellent evolution.

Authors/Disclosures
Lucrecia Bandeo PRESENTER	Lucrecia Bandeo has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Pablo Shubaroff	No disclosure on file
	No disclosure on file
	No disclosure on file
Maria G. Cersosimo, MD	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Javier Halfon, MD	No disclosure on file
	No disclosure on file
Maria S. Pacha	No disclosure on file
Marcela Uribe Roca (Hospital De Clinicas)	The institution of Marcela Uribe Roca has received research support from Roche.
Pablo Bonardo, MD	Dr. Bonardo has nothing to disclose.
	No disclosure on file
Ricardo C. Reisin, MD (Hospital Britanico)	Dr. Reisin has nothing to disclose.

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