Percheron arterial Stroke- an uncommon cause of stroke in children

Background:

Ischemic stroke is rare in the pediatric population and the diagnosis is often delayed , resulting in suboptimal treatment and unfavorable outcome.

Artery of Percheron is a normal variant in the paramedian branches of the posterior cerebral artery, present in roughly ten percent of the population. This artery supplies the paramedian areas of the thalami and upper midbrain.

Occlusion of this artery is rare and can result in a variety of neurologic symptoms, mainly nonspecific and non-localizing symptoms.

Case presentation:

A healthy 16 yo was brought to the pediatric emergency department (PED) with episodes of confusion, slurred speech and multiple falls over one hour prior to arrival with no obvious seizure. There was no pr

In the PED he had fluctuating levels of consciousness and apneic events. A toxic screen was negative. Non-contrast CT was read as normal. Stroke protocol MRI showed restrictive changes in the thalamus bilaterally with no abnormal signal in FLAIR.

Diagnosed as arterial ischemic stroke due to artery of Percheron occlusion the boy was treated with tPA, approximately 6 hours from the beginning of symptoms.

After cessation of sedation the boy regained full neurologic function with no deficits.

No cardiac or hematologic etiology for his stroke was found.

Discussion:

Artery of Percheron occlusion is a rare cause for ischemic stroke in adults and extremely rare in children.

In this case, high index of suspicion and timely treatment resulted in a favorable outcome.

Ischemic stroke remains a diagnostic and therapeutic challenge in children and requires high index of suspicion and multidisciplinary approach.