BACKGROUND: Occlusion of the Artery of Percheron leads to a distinctive pattern of ischemia, manifesting as bilateral paramedian thalamic involvement, with or without midbrain involvement. While the classic imaging findings are frequently acknowledged, the literature reveals a scarcity of reported cases, limited mostly to small case series and isolated instances of Artery of Percheron infarction. AIM: This study aimed to comprehensively characterize the imaging spectrum of Artery of Percheron (AOP) infarction based on cases obtained from our institute. MATERIALS AND METHODS: Study Design : Hospital based Retrospective study Study area:, Department of Radio Diagnosis , Dr. Pinnamaneni Siddhartha Institute Of Medical Sciences And Research Foundation, Chinaoutpally, Krishna District Vijayawada. Study period: 5 years (between 2017 and 2022 ) Sample size: we reviewed the imaging and clinical data of 25 patients diagnosed with Artery of Percheron (AOP) infarction. The primary inclusion criterion for imaging analysis was the presence of abnormal signal intensity on MR imaging, specifically involving the distinct arterial territories of the bilateral paramedian thalami, with or without rostral midbrain involvement. Exclusion criteria encompassed cases with neoplastic, infectious, or inflammatory etiologies. RESULTS: We identified 4 ischemic patterns of AOP infarction: 1) Bilateral paramedian thalamic with midbrain (56%), 2) Bilateral paramedian thalamic without midbrain (28%), 3) Bilateral paramedian thalamic with anterior thalamus and midbrain (12%), and 4) Bilateral paramedian thalamic with anterior thalamus without midbrain (4%). CONCLUSION: Artery of Percheron (AOP) infarctions should be considered among potential causes for sudden alterations in consciousness. The preferred diagnostic modality is MRI. The identification of four distinct ischemic patterns in our case series enhances the ability to recognize AOP infarction, thereby aiding in the neurologic evaluation and management of patients presenting with thalamic strokes.

Occlusion of the Artery of Percheron leads to a distinctive pattern of ischemia, manifesting as bilateral paramedian thalamic involvement, with or without midbrain involvement.