Presentation
The patient arrived at the emergency ward with loss of consciousness. Prior CTA showed no acute lesion or large vessel occlusion.
Patient Data
There is restricted diffusion in both thalami and the left side of the midbrain due to acute ischemia. These lesions are also bright on the FLAIR sequence.
There are multiple old ischemic lesions in the left MCA territory and the frontal lobe on the right side (ACA territory). Around the ventricles and in the semioval center high FLAIR signal suggests chronic hypoperfusion.
In the right parietal lobe, a partial sclerotic parafalcial meningioma is seen.
Case Discussion
The patient arrived at the ER with a loss of consciousness. She had multiple old left MCA and right ACA territory old infarcts and known SLE and antiphospholipid syndrome. This patient has a higher risk of ischemic stroke. Cardiogenic (atrial fibrillation) or atherosclerotic embolus could also be in the background.
Bilateral thalamic and mesencephalic infarcts are typical for Percheron territory infarct. Basilar artery occlusion ( top of the basilar syndrome) could be in the differential. Still, there was no basilar artery occlusion on the CTA, and the lack of PCA involvement also supports the Percheron territory infarction.
Artery of Percheron is a rare anatomical variant when a solitary artery supplies both thalami and the midbrain bilaterally.
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