A 55 year old male presented with altered level of consciousness and vertical gaze palsy.

1. What is the diagnosis?

2. Which of the follow could also be included in the differential for bilateral thalamic

Hypodensities on CT?

Correct answer:

1. What is the diagnosis?

 Artery of Percheron infarct

2. Which of the follow could also be included in the differential for bilateral thalamic Hypodensities on CT?

A. Wernicke-Korsakoff

B. Internal Cerebral Vein Thrombosis

C. Top of the Basilar Syndrome

Little anatomy? 

The Artery of Percheron arises from Unilateral PCA  and supplies  Bilateral Thalamus + Midbrain

The artery of Percheron is a rare vascular variant, in which a single common trunk arises from one of the

PCAs to supply both thalami and the midbrain.

KEY FEATURES

- This is a unique example of a unilateral blood vessel supplying structures on both sides of the midbrain.

- Occlusion of the Artery of Percheron will cause a bilateral infarction of the thalamus and a “V-Shaped” infarct of the rostral midbrain

- On CT, occlusion of the bilateral cerebral veins, occlusion of the tip of basilar artery, or even Wernickes can give a similar appearance.

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