Strategic Infarct, Artery of Percheron Infarction: A Case Report.

Abstract

A 78-year-old Thai woman presented with memory loss, confusion, and psychomotor retardation which gradually worsened over 2 days. She denied fever, weakness, numbness and visual or auditory hallucination, and was alert and oriented to time, place and person. Upon thorough neurological examination, her results were normal except for MoCA 27/30. Laboratory work-up which included complete blood count and blood chemistry were within normal limits. An MRI brain showed restricted DWI at bilateral paramedian thalami with a diagnosis of artery of Percheron infarction. Although the patient did not present with the classic triads of artery of Percheron infarction, i.e. alteration of consciousness, neuropsychological abnormalities, and vertical gaze paresis, physicians were finally able to conclude on a definitive diagnosis with a thorough physical examination to help indicate appropriate investigation and diagnostic measures. In summary, it is encouraged to perform complete a neurological examination including neuropsychological tests in every patient who presents with neuropsychological abnormalities.