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Neurological Rehabilitation

Percheron Artery Infarct in A 41-Year-Old Female: A Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 6

    Primary Author(s)

  • Benjamin Haight, DO

    Resident Physician
    HCA Healthcare Sunrise Health Graduate Medical Education PM&R Program
    Las Vegas, Nevada

    • Co-Author(s)

  • KH

    Kevin Huang, DO

    Resident Physician
    HCA Healthcare Sunrise Health Graduate Medical Education PM&R Program
    Las Vegas, Nevada

  • BW

    Bryan Werner, MD, MPH

    Associate Program Director
    HCA Healthcare Sunrise Health Graduate Medical Education PM&R Program
    Las Vegas, Nevada

    • Poster Presenter(s)

  • RK

    Ramtin Khalafi, DO

    Resident Physician
    HCA Healthcare Sunrise Health Graduate Medical Education PM&R Program
    Las Vegas, Nevada

Disclosure(s):
Benjamin Haight, DO: No financial relationships to disclose
Case Diagnosis: Frequent falls related to bilateral thalamic infarct and peripheral neuropathy

Case Description or Program Description: 41-year-old female with malnutrition secondary to eating disorder, osteoporosis, peripheral neuropathy and low back pain with failed spinal cord stimulator presented as referral for frequent falls with inconsistent event recall and no medical records on evaluation. She reported 3-year history of frequent falls requiring use of rollator. Exam notable for frail female with slow, deliberate and dysarthric speech, wide based ataxic gait, decreased bilateral lower extremity strength (4/5) and normal deep tendon reflexes. Further neurologic testing showed impaired heel to shin, dysmetria and dysdiadochokinesia with impaired vibratory and positional sensation. Spine imaging showed early degenerative changes without significant canal or neuroforaminal stenosis. MRI brain ordered due to cerebellar symptoms, showed symmetric 4mm chronic infarcts of the bilateral thalami consistent with artery of Percheron (AOP) infarct. Electrodiagnostic tests suggested distal axonal polyneuropathy involving motor more than sensory segments.

Setting: Outpatient physiatry clinic

Assessment/Results: Patient was referred to neurology for post stroke recommendations and physical therapy for lower extremity strengthening, gait and balance training.

Discussion (relevance): Bilateral thalamic involvement in AOP infarcts are rare conditions where a single arterial supply to the thalamic and midbrain regions are compromised. Challenges lie in diagnosis due to rarity and diverse clinical presentation. Research shows only 4-12% of people have an AOP and only 0.1% of ischemic and 4% of thalamic strokes are associated with AOP infarcts. Symptoms of AOP infarcts vary but can include visual disturbance, memory impairment, speech impairment, motor and cerebellar symptoms.

Conclusions: This case highlights the importance of detailed physical exam and prompt imaging in patients with unexplained neurologic symptoms; especially with poor patient history recall due to undiagnosed cognitive deficits. Although rare, AOP infarcts should be considered as symptoms can mimic other common neurologic diagnoses and delayed care can lead to untreated cerebrovascular infarct risk factors.