80 Sleeping Beauty

Background The artery of Percheron is a rare anatomic variant of arterial supply to the paramedian thalamus and rostral midbrain, and occlusion of the artery of Percheron results in bilateral paramedian thalamic infarcts with or without midbrain involvement. Early diagnosis of artery of Percheron infarction can be challenging because it is infrequent and early computed tomography or magnetic resonance imaging may be negative. Thus, it can be confused with other neurological conditions such as tumours and infections. Methods This is a retrospective case study of a gentleman admitted to a teaching Hospital in Limerick and diagnosed with an artery of Percheron infarction. Medical records and the neuro-radiological database were reviewed, and the diagnosis was made based on typical symptoms and radiological findings of artery of Percheron infarction. Results We report the case of a gentleman who was found unconscious in his car on the roadside during the daytime. He had a decreased GCS and upon arrival in the Emergency Department he was intubated and transferred to ITU The initial head computed tomography performed on admission was reported as unremarkable. Bilateral ischemia in the paramedian thalamic nuclei was documented on a follow-up computed tomography on day 24 after hospitalization. He was extubated after 24 hours. He made a full recovery and was discharged home on day 5. Conclusion Artery of Percheron infarcts are rare. The radiological diagnosis can initially often be judged as normal and in combination with variability in the neurological symptoms it is a rather difficult condition to diagnose.