# Artery of Percheron Infarction Presenting As Altered Consciousness in an Elderly Patient: A Case Report

## TL;DR

An elderly patient with altered consciousness was found to have a rare stroke caused by artery of Percheron infarction, highlighting the importance of timely neuroimaging.

## Contribution

This case report highlights the rare and challenging clinical presentation of artery of Percheron infarction in an elderly patient.

## Key findings

- The patient presented with sudden unresponsiveness and later developed facial weakness and ptosis.
- DWI-MRI confirmed acute ischemic changes consistent with artery of Percheron occlusion.
- The patient's condition rapidly deteriorated and resulted in death.

## Abstract

Bilateral thalamic infarcts represent an uncommon manifestation of acute ischemic stroke, often resulting from occlusion of the artery of Percheron (AOP). Thereby, we report the case of an 86‐year‐old female with a background of multiple comorbidities who presented with sudden-onset unresponsiveness. Her Glasgow coma scale (GCS) score on admission was 10/15. Non-contrast computed tomography (NCCT) of the head ruled out intracranial hemorrhage. While being empirically managed for a suspected meningitis, the patient’s admission was complicated by a marked reduction in her GCS (5/15) along with new-onset left-sided facial weakness and ptosis. On admission day 6, a diffusion‐weighted magnetic resonance imaging sequence (DWI‐MRI) revealed acute ischemic changes in the midbrain and bilateral thalami, which were consistent with the occlusion of AOP. The patient deteriorated very quickly and passed away during the same admission. This case illustrates the elusive clinical presentation of AOP infarction and underscores the urgent need for adequate neuroimaging to avoid any unwarranted medical treatment.