ABSTRACT NUMBER: ESOC2026A46 TO THROMBOLYSIS OR NOT TO THROMBOLYSIS? THE ARTERY OF PERCHERON: AN ANATOMICAL ANOMALY WITH DEVASTATING CLINICAL CONSEQUENCES

Abstract Background and aims The Artery of Percheron (AOP) is a solitary, rare artery arising from a proximal segment of the posterior cerebral artery supplying both paramedian thalami. 4-12% of the population are reported to have this variant. Infarction of this artery, leads to presentations including coma, gaze palsies, agitation and confusion. Investigation with CT head and CT angiogram will fail to show occlusion of this artery due to its size. MRI with DWI remains the investigation of choice, with imaging showing bilateral hypoattenuation of the thalami. AOP infarction is an important differential that should be considered for patients presenting obtunded, comatose or confused. Methods We present the case of a 70-year-old who presented within the thrombolysis window, obtunded and comatose with a Glasgow Coma Scale of 8/15 and an NIHSS score of 11 following a sudden onset headache. Emergency imaging of their brain including CT head and CT angiogram was normal, given the uncertainty and possibility of thrombolytic therapy, urgent MRI imaging with DWI was arranged demonstrating bilateral paramedian thalamic diffusion restriction, reported as artery of Percheron infarction. Results Our patient was successfully thombolysed within the thrombolysis window and a positive diagnosis of Artery of Percheron infarction was made. Our patient was trasfered to the hyperacute stroke unit and underwent multidisciplinary team review. Conclusions Artery of Percheron infarction whilst rare, remains an important diagnosis and stroke chameleon. Early imaging with MRI is a life changing investigation with significant consequences if not considered acutely. Conflict of interest Dr Morgan Hayden: Nothing to disclose, Dr Naama Raquib: Nothing to disclose, Dr Suheil Ponnambath: Nothing to disclose, Dr Divya Toraskar: Nothing to disclose, Nazia Zaman (PA): Nothing to disclose