Teaching NeuroImages: Artery of Percheron thrombosis causing selective downgaze palsy

A 47-year-old man with migraines presented with sudden onset of vertical diplopia, dysarthria, right facial weakness, and downgaze palsy (figure 1). Brain MRI revealed ischemic strokes in the midbrain periaqueductal gray, bilateral thalamic–midbrain junction, and thalamus (figure 2, A–C). Gradient echo and T1 MRI showed hypointensity in the interpeduncular fossa (figure 2, D and E). No flow could be visualized in this structure on CT angiogram or catheter angiogram, demonstrating a thrombosed artery of Percheron (figure 2, F–H). Downgaze palsy, which improved 18 months later, may result from bilateral lesions of the mesencephalic–diencephalic junction involving the rostral interstitial nucleus of the medial longitudinal fasciculus.1,2

Source: Neurology - October 16, 2017 Category: Neurology Authors: Sechler, M., Singh, J., El Husseini, N. Tags: MRI, DWI, All Cerebrovascular disease/Stroke, Infarction RESIDENT AND FELLOW SECTION Source Type: research