# Bilateral Thalamic Infarction Due to Artery of Percheron Occlusion in a Young Patient With Hyperhomocysteinemia and Vertebral Artery Dissection

## TL;DR

A young man suffered brain damage from a rare artery blockage linked to high homocysteine and neck manipulation, stressing the need for quick diagnosis.

## Contribution

This case highlights the rare occurrence of AOP occlusion in a young patient with atypical cerebrovascular symptoms.

## Key findings

- MRI confirmed bilateral thalamic infarction due to AOP occlusion in a 20-year-old male.
- Hyperhomocysteinemia and vertebral artery dissection were identified as potential causes.
- The patient experienced lasting cognitive and motor impairments despite treatment.

## Abstract

The artery of Percheron (AOP) is a rare anatomical variant supplying the bilateral paramedian thalami and the rostral midbrain. Its occlusion represents a diagnostic challenge due to the variability in clinical presentation. We report the case of a 20-year-old male who was admitted with altered consciousness and nonspecific neurological symptoms. Magnetic resonance imaging (MRI) demonstrated a characteristic bilateral thalamic infarction consistent with AOP occlusion. Etiological workup revealed hyperhomocysteinemia and a right vertebral artery dissection, the latter suspected to be secondary to chiropractic cervical manipulation. Despite medical treatment and rehabilitation, the patient experienced significant cognitive and motor sequelae. This case highlights the importance of clinical suspicion and prompt diagnosis of AOP occlusion in young patients with atypical cerebrovascular events, emphasizing the need for a comprehensive evaluation to optimize management and improve prognosis.