Artery of Percheron territory infarct in a young patient with thrombophilia

Context: Stroke, when affecting territories dependent on posterior circulation, affects the thalamus and mesencephalic structures, regions irrigated by the paramedian arteries and perforating arteries of the posterior communicating artery and posterior cerebral artery. However, there is an anatomical variant of the paramedian arteries, the Percheron artery, when occluded causes bilateral thalamic infarction. Case report: a 53-year-old woman who presented blurred vision, holocranial headache, hypertensive peak, decreased level of consciousness, anisocoria, conjugate eye deviation. Tomography was normal and after 48 hours there was periventricular hypodensity of white matter, corona radiate and bilateral thalamic. Cerebral angiography confirmed moderate stenosis in the cavernous segments of the internal carotid arteries. In the investigation, a heterozygous mutation for factor V of Leiden was found. The patient evolved well, after blood pressure control and secondary prophylaxis. Clinical picture brings the classic triad of Percheron Artery infarction: decreased level of consciousness, vertical changes in the look and cognitive changes in memory and learning. Other symptoms could be found hypersomnia, oculomotor paralysis and ataxia. The diagnosis is clinical and radiological by visualizing bilateral thalamic involvement. Predisposing factors should be investigated, such as the Leiden factor V mutation, which increases thromboembolic events. Conclusion: It is important to research risk factors and execute an early diagnosis for acute intervention and prophylaxis of stroke.