Bilateral Thalamic Stroke Arising From an Occlusion of the Artery of Percheron: Barriers to Diagnosis, Management, and Recovery

A 90-year-old male patient presented with excessive somnolence, right-sided weakness, and left facial droop. CT and MRI scans of the head, taken several days after initial head CT proved to be non-revealing, demonstrated a bilateral thalamic stroke, a rare phenomenon. The infarct arose in the territory of the artery of Percheron, an anatomic variant in which a single artery supplies both sides of the thalamus and midbrain. When this artery becomes occluded, it results in severely dysregulated consciousness and alertness. This type of stroke proved challenging for the medical team, due to poor resolution of initial imaging, as well as the therapy teams, due to the constant need for sleep. This case report outlines how barriers in diagnosis and management make knowledge of the artery of Percheron and its occlusion crucial to patient care and recovery.