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|Year : 2019 | Volume
| Issue : 3 | Page : 927
V-shaped MRI change in the midbrain of a patient with artery of Percheron infarction
Yuya Kobayashi, Hiroyuki Yahikozawa, Shunichi Sato
Department of Neurology, Nagano Red Cross Hospital, Wakasato, Nagano, Japan
|Date of Web Publication||23-Jul-2019|
Dr. Yuya Kobayashi
Department of Neurology, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano, 380-8582
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kobayashi Y, Yahikozawa H, Sato S. V-shaped MRI change in the midbrain of a patient with artery of Percheron infarction. Neurol India 2019;67:927
A 68-year old man presented with acute onset bilateral ptosis [Figure 1]a. He was taking apixaban and cilostazol for atrial fibrillation and angina pectoris. Upon admission, he was alert, and his pupils were dilated 5 mm and unreactive to light. He developed paralysis of eye movements, except for lateral rectus, consistent with bilateral oculomotor paralysis [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f, [Figure 1]g. In addition, the patient had left hemianopsia. He did not have quadriplegia or any other neurological symptoms; these symptoms developed 12 h before admission and never improved. Anti-acetylcholine receptor antibodies were negative, whereas serum vitamin B1 and B12 levels were normal. Furthermore, diffusion-weighted magnetic resonance imaging (MRI) revealed infarction of bilateral thalami, rostral midbrain, and right occipital lobe [Figure 1]h and [Figure 1]i. He was diagnosed with artery of Percheron (AOP) and posterior cerebral artery (PCA) infarction. Bilateral paramedian thalamic stroke is characterized by vertical gaze palsy, memory impairment, and coma; however, our patient developed only bilateral oculomotor nerve paralysis. Moreover, cerebral peduncle infarction affected only the oculomotor nerve emerging from the brainstem. The nearby oculomotor nucleus and interstitial nucleus of Cajar remained unaffected. The thalami and midbrain are supplied by several small arterial branches exhibiting significant variability. AOP is an uncommon variant arising from PCA supplying bilateral thalami with rostral midbrain. A study reported that AOP infarction occurred in only 0.6% of 2750 patients with ischemic stroke, and AOP is rarely visualized after infarction.,,, Our patient demonstrated a typical V-shaped MRI change in the midbrain, which was reported in 67% of patients with AOP infarction.
|Figure 1: (a) The patient was unable to open his eyes. (b-f) The eye movement was possible only for adduction. (g) The pupils were unreactive to light. (h and i) Diffusion-weighted MRI revealing infarction of the thalamus and anterior cerebral peduncle bilaterally and of the right occipital lobe. The V-shaped hyperintense signal intensity in the midbrain is characteristic|
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