Artery of Percheron Infarction Presenting With Profound Autonomic Dysfunction

Artery of Percheron (AOP) occlusion is an uncommon type of stroke that results in posterior circulation infarction involving the bilateral paramedian thalami and midbrain. It can present with various clinical features. We describe a case of a male patient with multiple medical comorbidities who presented with a depressed level of consciousness accompanied by significant autonomic instability, characterized by profound bradycardia necessitating transvenous pacing. Serial brain computed tomography (CT) confirmed the presence of bilateral paramedian thalamic and midbrain infarctions within the AOP territory. This case highlights the importance of recognizing the uncommon clinical features of AOP infarction and ensuring a timely intervention in patients presenting with severe autonomic dysfunction and altered mental status.