Infarction in the territory of the Artery of Percheron(AOP) is a rare cause of acute altered mental status, classically presenting with vertical gaze palsy and memory impairment. This specific stroke pattern accounts for approximately 0.1% to 2% of all ischemic strokes. Though classically embolic, this can also occur from global cerebral hypoperfusion. This report describes a 26-year old male who developed this specific infarct in the setting of suicidal hanging. Initial Magnetic Resonance Imaging(MRI) confirmed acute bilateral paramedian thalamic ischemia. Despite neuroprotective management and physical recovery, follow-up imaging demonstrated right hippocampal atrophy. The patient remained with severe cognitive deficits, notably anterograde amnesia, corresponding to combined thalamic and hippocampal injury. This case emphasizes hanging as an etiology for Artery of Percheron infarction, chronicles the progression from focal ischemia to broader atrophy, and provides emphasis on profound neurocognitive disability over the long term that becomes the determinant of prognosis in such survivors.
Sankhi et al. (Sat,) studied this question.