Bilateral ptosis and ophthalmoparesis as atypical presentations of Percheron artery infarction: Case report

The Percheron artery is a rare arterial variant that irrigates the thalamic region bilaterally. Infarction due to obstruction of the Percheron artery has been reported at a frequency between 0.1 to 2% and classically causes an alteration in the level of consciousness, neurocognitive disorder and vertical gaze palsy. We present a 70-year-old female patient with altered level of consciousness, involvement of vertical gaze palsy, ophthalmoparesis and bilateral ptosis. The patient progressed with partial improvement of symptoms: she persisted severe bilateral ptosis and paresis of vertical gaze with slight improvement of the alteration of horizontal gaze and bilateral internuclear ophthalmoplegia. In conclusion, we report the atypical case of an infarction of the artery of Percheron and describe the anatomical substrate for presenting these clinical signs. It is important to suspect a possible case in every patient with symptoms of compromised level of consciousness and alteration in ocular mobility since this will allow us to make a timely diagnosis and treatment.