# Artery of Percheron Infarction Presenting With Profound Autonomic Dysfunction

## TL;DR

This paper reports a rare stroke case involving the Artery of Percheron, leading to severe autonomic dysfunction and altered consciousness.

## Contribution

The case highlights the uncommon presentation of autonomic instability in AOP infarction.

## Key findings

- The patient exhibited profound bradycardia requiring transvenous pacing due to AOP infarction.
- Bilateral paramedian thalamic and midbrain infarctions were confirmed via serial brain CT scans.
- The case emphasizes the need for timely intervention in similar presentations.

## Abstract

Artery of Percheron (AOP) occlusion is an uncommon type of stroke that results in posterior circulation infarction involving the bilateral paramedian thalami and midbrain. It can present with various clinical features. We describe a case of a male patient with multiple medical comorbidities who presented with a depressed level of consciousness accompanied by significant autonomic instability, characterized by profound bradycardia necessitating transvenous pacing. Serial brain computed tomography (CT) confirmed the presence of bilateral paramedian thalamic and midbrain infarctions within the AOP territory. This case highlights the importance of recognizing the uncommon clinical features of AOP infarction and ensuring a timely intervention in patients presenting with severe autonomic dysfunction and altered mental status.