Contemporary therapeutic strategies for occlusion of the artery of Percheron: a review of the literature.

The artery of Percheron (AOP) is a rare anatomic variant of the paramedian thalamic-mesencephalic arterial supply, arising as a solitary arterial trunk from the P1 segment of the posterior cerebral artery. Its occlusion, commonly caused by cardioembolism, leads to distal bilateral paramedian thalamic ischemia, oftentimes affecting the midbrain and/or the anterior thalamus. AOP occlusion presents with a clinical triad of altered mental status, vertical gaze palsy, and memory impairment, along with other associated symptoms. Digital subtraction angiography is effective for detecting AOP, while diffusion weighted MRI is best for diagnosis of its occlusion. Our extensive literature search sought to determine the best forms of treatment for uncomplicated AOP occlusion, with the inclusion criterion of implementation of medical treatment or other forms of therapy in patient recovery from this condition. We conclude that intravenous heparin and thrombolysis with tissue plasminogen activator are effective firstline treatment options for emergent AOP occlusion followed by a prescription of long term anticoagulants, while non-emergent cases without midbrain involvement could be treated through rehabilitation and continual monitoring by medical staff. Clinical trials of higher power are needed for a more comprehensive analysis of the treatment options for AOP occlusion.

Redefining thalamic vascularization vicariously through gerald percheron: a historical vignette.

Gerard Percheron, M.D., a practicing neurologist and prolific researcher at the Institute Nationale de la Sante et de la Recherche Medicale (INSERM), made significant and valuable contributions to medicine, in particular, to the vascular anatomy of the basal ganglia. His particular interest in the thalamus eventually led to the identification of an anatomic variation in its vascular supply. This newly identified artery was subsequently named the artery of Percheron (AOP). Given the estimated prevalence of the AOP in up to one third of the population and its significant proportion of all thalamic infarcts, it is necessary for physicians to be aware of this anatomic vascular variant and its clinical consequences. Although occlusion of the AOP may present similar to other arterial thalamic occlusions, it can be identified through susceptibility-weighted imaging and ruled out with conventional or magnetic resonance angiography. Occlusion of the AOP typically causes a simultaneous and symmetric infarction. Treatment efficacy is time-dependent and necessitates thrombolytics and anticoagulative medications. Here, we trace a course from the artery's initial description in 1973 to its current implications in cerebrovascular stroke, and offer a synopsis of the proposed treatment.