Clinical Study On Percheron Artery Syndrome In9Subjects

Objective: Percheron artery syndrome is uncommon in clinic.Themain mechanism is occlusion of artery of percheron (AOP) which arisesfrom the P1segment of unilateral posterior cerebral artery.The AOPocclusion results in a characteristic pattern of ischemia: bilateralparamedian thalamus with or without midbrain involvement. The purposeof this study is to improve the recognition and diagnosis of Percheronartery syndrome and thus, clinicians could take rational treatment in timeand improve patients’prognosis.Methods:The clinical data of9patients with Percheron arterysyndrome were analyzed together with the clinical presentations,neuroimaging findings, diagnosis, treatment and prognosis. Reviewingliterature and summarizing the clinical characteristic of Percheron arterysyndrome.Results: Among the9patients with Percheron artery syndrome,5cases were male patients and4cases were female. The age range of9patients was44~83years old, and the mean age was67years old.One patient was onset after splenectomy.6cases had hypertension, and2caseshad diabetes mellitus.One patient has occurred postcirculational transientischemic attack （TIA） for many times.2cases have occurred braininfarction before. One patient had Rheumatic heart disease with atrialfibrillation.5cases were smokers. Percheron artery syndrome was typicallycharacterized by a triad of conscious disorder, memory impairment andvertical gaze limitation. Our9cases were all acute onset with differentlevels of conscious disorder.Among them,3had vertical gaze limitation,one with left-sided ptosis,6with limb weakness， and one withhallucination and burning pain.4cases were recorded with memorydisorder, and2without memory disorder.All cases had head ComputedTomograph (CT) examination after symptoms onset, and4cases indicatedthe CT hypoattenuation in bilateral paramedian thalamus. All cases hadMagnetic Resonance Imaging (MRI) examination within72hours aftersymptoms onset. All showed hypointensity on T1WI and hyperintensity onT2WI in bilateral paramedian thalamus, two of which had a “V” signal inmidbrain.4patients had Magnetic Resonance Arteriography （MRA）orComputed Tomograph Arteriography（CTA）examination, but all did notfind the AOP.All patients were by ischemic stroke treatment. Discharge of6cases clinical improvement, an average follow-up of1.15years, onlyone case fully recovered, and other cases got vertical gaze limitation,limbweakness and the cognition disorder. Conclusion：Percheron artery syndrome is mainly characterized by acuteonset,different levels of conscious disorder, vertical gaze limitation,memoryimpairment.Brain CT/MRI examination indicates bilateral paramedian thalamuswith or without midbrain infarction.The “V”sign on FLAIR and DWI sequenceswith midbrain involvement supports the diagnosis of Percheron artery syndrome.Percheron artery syndrome is mainly by ischemic stroke treatment and has a poorprognosis.