Disclosures: Alexander J. Carrese, DO: No financial relationships or conflicts of interest

Case Description: Patient is a 62 year old male that presented to the hospital for blurry vision and diplopia with progression of symptoms resulting in left hemiparesis. He was initially given tPA but it was abandoned mid-administration due to thrombocytopenia. Patient was intubated for airway protection and admitted for further workup. MRI brain ultimately revealed bilateral thalamic and midbrain strokes consistent with an Artery of Percheron (AoP) infarct.

Setting: Inpatient Rehabilitation Facility

Patient: 62 year old male Assessment/

Results: Patient was in the acute care setting for 17 days and inpatient rehab for 26 days with ultimate transition to a long-term care brain injury facility. During his stay on inpatient rehab, there were many difficulties managing the patient that were consistent with bilateral thalamic and midbrain infarcts. The classic triad of an AoP infarct include altered mental status, memory impairment, and vertical gaze palsy. Other complications include bradycardia, hypersomnolence, ataxia, and dysphagia. He was able to increase his functional status over most modalities but due to continued need for 24/7 care and mental status/comprehension complications, it was decided that the patient needed additional time to recover prior to going back home.

Discussion: The Artery of Percheron is a rare anatomical variant, in which the bilateral thalami are supplied by a single artery as a branch from the posterior cerebral artery. Infarcts consistent with this account for approximately 0.2-2% of all ischemic Strokes. Occlusion of the AoP causes an infarct that can be characterized by the “V-sign” on MRI. Symptoms of this diagnosis can vary depending on the extent of blood supply to the thalami and/or involvement of the midbrain.

Conclusion: This case highlights and reviews a rare anatomical variant stroke that can be severely debilitating in both acute and long term care settings.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/artery-of-percheron-stroke-in-the-inpatient-rehabilitation-setting-a-case-report/