RESIDENT AND FELLOW PAGE Teaching NeuroImage Acute bilateral paramedian thalamic infarcts after occlusion of the artery of Percheron Guy Raphaeli, MD; Anatoly Liberman, MD; John M. Gomori, MD; and Israel Steiner, MD A 55-year-old man with diabetes and hypertension presented with sudden onset of transient somnolence. When he woke up, gait ataxia was noted. This was followed by recurrent fluctuations in consciousness and skew deviation. An urgent neuroimaging protocol for stroke demonstrated symmetric bilateral hyperintense thalamic lesions on diffusionweighted MRI (figure), consistent with acute ischemic events and compatible with occlusion of the artery of Percheron. The large arteries of the posterior circulation, including the tip of the basilar artery, were fully patent on magnetic resonance angiography. The central artery of Percheron arises from the first segment of the posterior cerebral artery and gives rise to bilateral medial thalamic perforants.1 Occlusion results in bilateral paramedian thalamic infarctions. This is one of the few examples where a cerebral blood vessel supplies structures on both sides of the midline. Reference 1. Percheron G. Arteries of the human thalamus: II. Arteries and paramedian thalamic territory of the communicating basilar artery [in French]. Rev Neurol (Paris) 1976;132:309– 324. Figure. (A) Diffusion-weighted imaging. (B) T2* gradient echo MRI. Images show abnormal hyperintense bilateral paramedian thalamic lesions (arrows). (C) Apparent diffusion coefficient image demonstrating the same lesions with diffusion restriction (arrows). (D) Magnetic resonance angiography demonstrating patent basilar artery (arrow) and posterior cerebral arteries. From the Departments of Neurology (G.R., A.L., I.S.) and Radiology (J.M.G.), Hadassah University Hospital, Jerusalem, Israel. Disclosure: The authors report no conflicts of interest. Received April 28, 2005. Accepted in final form August 2, 2005. Address correspondence and reprints requests to Dr. Israel Steiner, Department of Neurology, Hadassah Hebrew University Hospital, PO Box 12000, Jerusalem, 91120 Israel; e-mail: isteiner@md.huji.ac.il Copyright © 2006 by AAN Enterprises, Inc. E7 Acute bilateral paramedian thalamic infarcts after occlusion of the artery of Percheron Guy Raphaeli, Anatoly Liberman, John M. Gomori, et al. Neurology 2006;66;E7 DOI 10.1212/01.wnl.0000191320.49534.7c This information is current as of January 9, 2006 Updated Information & Services including high resolution figures, can be found at: http://www.neurology.org/content/66/1/E7.full.html References This article cites 1 articles, 0 of which you can access for free at: http://www.neurology.org/content/66/1/E7.full.html##ref-list-1 Citations This article has been cited by 4 HighWire-hosted articles: http://www.neurology.org/content/66/1/E7.full.html##otherarticles Permissions & Licensing Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/misc/about.xhtml#permissions Reprints Information about ordering reprints can be found online: http://www.neurology.org/misc/addir.xhtml#reprintsus Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright . All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.