Keywords
Thalamus
Posterior cerebral artery
Anatomical variation
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Abstract
Objective: To review the scientific literature on bilateral thalamic infarction caused by occlusion of the artery of Percheron (AOP), highlighting anatomical, epidemiological, clinical, diagnostic, differential, therapeutic, and prognostic aspects. Literature review: The AOP is a rare anatomical variation of the posterior cerebral circulation, supplying the bilateral paramedian thalamic region and, occasionally, the rostral midbrain. Its occlusion leads to an uncommon pattern of bilateral thalamic infarction, often underdiagnosed due to nonspecific symptoms, such as decreased level of consciousness, oculomotor disturbances, and memory deficits. CT scans may initially appear normal, while MRI is more sensitive, with the “V sign” being a characteristic finding. Differential diagnoses include metabolic encephalopathies, encephalitis, and cerebral venous thrombosis. Treatment follows protocols for ischemic stroke, including the possibility of intravenous thrombolysis and intensive clinical support. Final considerations: Early recognition of AOP is essential for effective management and reduction of neurological sequelae. Healthcare professionals should consider this rare condition as a potential cause of bilateral thalamic infarctions, especially in the presence of atypical clinical presentations.
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