The lady who went twenty years back in her life – a case of acute bilateral thalamic infarction due to artery of percheron involvement

The thalamic and midbrain region of the brain is supplied by a complex arrangement of blood vessels fed by a large number of arteries1,2. Although variations exist, the perforating branches from the posterior cerebral artery and the posterior communicating artery provides the main arterial supply to this area3. The artery of Percheron (AOP) is a rare variant of this blood supply, with a frequency of occurence of 4-10% of all thalamic strokes and 0.2-2% of all ischaemic strokes4. The AOP is a single trunk which arises from the first segment of the posterior cerebral artery and supplies blood to the thalamus bilaterally5. Occlusion of this common arterial trunk leads to typical mirror-like symmetric bilateral thalamic infarctions which could be considered pathognomonic of occlusion of the artery of Percheron.