Varied Manifestations of Artery of Percheron Stroke: A Clinical Case Series

Artery of Percheron (AOP) stroke, a rare anatomical variant resulting in bilateral thalamic infarction, presents with diverse clinical manifestations. We present a case series of six patients, highlighting the variability in clinical presentation, diagnostic challenges, management strategies, and outcomes associated with this condition. Variants in stroke presentation include altered sensorium, involuntary movements, and respiratory compromise. Imaging findings reveal bilateral paramedian thalamic infarcts, often involving adjacent structures. Management involves multidisciplinary care with emphasis on early recognition, supportive measures, and tailored rehabilitation. Our series underscores the importance of considering AOP stroke in patients presenting with atypical neurological symptoms, facilitating prompt diagnosis and intervention. Background: Artery of Percheron stroke, characterized by occlusion of a single common arterial supply to the bilateral thalami and other adjacent structures, is a rare but clinically significant entity. The anatomical variability predisposes to a wide spectrum of neurological deficits ranging from altered consciousness to focal neurological signs, posing diagnostic challenges often requiring advanced neuroimaging and multidisciplinary management. Materials and Methods: We conducted a retrospective review of six cases diagnosed with AOP stroke at our tertiary care facility between 2017 and 2021. Clinical data including demographics, presenting symptoms, physical examination findings, diagnostic imaging (CT, MRI, and angiography), laboratory investigations, treatment modalities, and outcomes were analyzed. Diagnostic criteria included characteristic neuroimaging findings confirming bilateral paramedian thalamic infarction consistent with AOP involvement.