Инсульт в бассейне артерии Першерона

Кулеш А.А., Дёмин Д.А. Инсульт в бассейне артерии Першерона. Consilium Medicum.
2024;26(11):734–738. DOI: 10.26442/20751753.2024.11.203049

© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.

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Kulesh AA, Demin DA. Artery of Percheron stroke: A review. Consilium Medicum. 2024;26(11): 734–738.
DOI: 10.26442/20751753.2024.11.203049

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Аннотация

Инфаркт в бассейне артерии Першерона – редкий вариант инсульта, при котором окклюзируется одна артериальная ветвь, кровоснабжающая оба таламуса и средний мозг, что приводит к развитию угнетения сознания, парезу вертикального взора и когнитивным нарушениям. Из-за атипичности симптомов («инсульт-хамелеон») диагноз часто верифицируется несвоевременно, что лишает пациента наиболее эффективного лечения – тромболитической терапии. Цель обзора – повысить осведомленность клиницистов о данном подтипе инсульта.

Ключевые слова: инсульт, артерия Першерона, тромболизис

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Ischemic stroke caused by the obstruction of the artery of Percheron is a rare type of ischemic stroke, in which one arterial branch supplying blood to both thalamuses and the middle brain is occluded, which leads to the depression of consciousness, paresis of vertical vision, and cognitive impairment. Due to the atypical symptoms ("stroke-chameleon"), the diagnosis is often not verified in time, which deprives the patient of the most effective treatment – thrombolytic therapy. The review aims to increase clinicians' awareness of this subtype of stroke.

Keywords: stroke, Artery of Percheron, thrombolysis

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Список литературы

1. Huff JS. Stroke mimics and chameleons. Emerg Med Clin North Am. 2002;20(3):583-95. DOI:10.1016/s0733-8627(02)00012-3
2. Кулеш А.А., Демин Д.А., Виноградов О.И. Дифференциальная диагностика ишемического инсульта в артериях вертебробазилярной системы. Неврология, нейропсихиатрия, психосоматика. 2023;15(5):13-9 [Kulesh AA, Demin DA, Vinogradov OI. Differential diagnosis of ischemic stroke in the arteries of the vertebrobasilar system. Neurology, Neuropsychiatry, Psychosomatics. 2023;15(5):13-9 (in Russian)]. DOI:10.14412/2074-2711-2023-5-13-1
3. Титов А.В., Мозговая О.Е. Таламический ишемический инсульт вследствие окклюзии артерии Першерона. Вестник рентгенологии и радиологии. 2020;101(2):121-5 [Titov AV, Mozgovaya OE. Thalamic Ischemic Stroke as a Result of the Occlusion of the Artery of Persheron. Journal of Radiology and Nuclear Medicine. 2020;101(2):121-5 (in Russian)]. DOI:10.20862/0042-4676-2020-101-2-121-125
4. Ciacciarelli A, Francalanza I, Giammello F, et al. Prevalence, clinical features, and radiological pattern of artery of Percheron infarction: a challenging diagnosis. Neurol Sci. 2023;44(7):2413-9. DOI:10.1007/s10072-023-06681-4
5. Percheron G. The anatomy of the arterial supply of the human thalamus and its use for the interpretation of the thalamic vascular pathology. Z Neurol.
1973;205(1):1-13. DOI:10.1007/BF00315956
6. Lazzaro NA, Wright B, Castillo M, et al. Artery of percheron infarction: imaging patterns and clinical spectrum. AJNR Am J Neuroradiol. 2010;31(7):1283-9.
7. Kichloo A, Jamal SM, Zain EA, et al. Artery of Percheron Infarction: A Short Review. J Investig Med High Impact Case Rep. 2019;7:2324709619867355. DOI:10.1177/2324709619867355
8. Atallah O, Almealawy YF, Alabide AS, et al. Navigating the clinical landscape of artery of Percheron infarction: A systematic review. eNeurologicalSci. 2024;37:100521. DOI:10.1016/j.ensci.2024.100521
9. Aaron S, Mani S, Prabhakar AT, et al. Stuck with a drowsy patient, evoke the Percheron. Neurol India. 2015;63(4):542-7. DOI:10.4103/0028-3886.162045
10. Arauz A, Patiño-Rodríguez HM, Vargas-González JC, et al. Clinical spectrum of artery of Percheron infarct: clinical-radiological correlations. J Stroke Cerebrovasc Dis. 2014;23(5):1083-8. DOI:10.1016/j.jstrokecerebrovasdis.2013.09.011
11. Agarwal N, Chaudhari A, Hansberry DR, Prestigiacomo CJ. Redefining thalamic vascularization vicariously through gerald percheron: a historical vignette. World Neurosurg. 2014;81(1):198-201. DOI:10.1016/j.wneu.2013.01.030
12. Jumean K, Arqoub AA, Al Hadidi MA, et al. Bilateral thalamic stroke due to occlusion of the artery of Percheron in a patient with a patent foramen ovale. J Nat Sci Biol Med. 2016;7(1):109-12. DOI:10.4103/0976-9668.175108
13. Zhang B, Wang X, Gang C, Wang J. Acute percheron infarction: a precision learning. BMC Neurol. 2022;22(1):207. DOI:10.1186/s12883-022-02735-w
14. Qaiser A, Lozano D, Liquigli N, et al. CT Perfusion Imaging Guides Clinical Decision-Making in a Case of Thalamic Stroke: A Case Report. Cureus. 2023;15(9):e44846.
15. Taydas O, Ogul Y, Ogul H. Association with clinic risk factors of Percheron artery infarction and magnetic resonance imaging involvement patterns. Acta Neurol Belg. 2022;122(2):411-5. DOI:10.1007/s13760-021-01697-z
16. Sparaco M, Ciolli L, Zini A. Posterior circulation ischaemic stroke-a review part I: anatomy, aetiology and clinical presentations. Neurol Sci. 2019;40(10):1995-2006. DOI:10.1007/s10072-019-03977-2
17. Van den Bergh WM, van der Schaaf I, van Gijn J. The spectrum of presentations of venous infarction caused by deep cerebral vein thrombosis. Neurology.
2005;65(2):192-6. DOI:10.1212/01.wnl.0000179677.84785.63
18. Kalita J, Sachan A, Dubey AK, et al. A clinico-radiological study of deep cerebral venous thrombosis. Neuroradiology. 2022;64(10):1951-60. DOI:10.1007/s00234-022-02938-5
19. Goyal S, Murumkar V, Kulanthaivelu K, et al. DC-CRP: Deep Cerebral Venous Thrombosis, Clinicoradiological Profile, and Treatment Outcome in Indian Population-A Tertiary Care Experience. J Assoc Physicians India. 2024;72(10):38-44. DOI:10.59556/japi.72.0610
20. Macedo M, Reis D, Cerullo G, et al. Stroke due to Percheron Artery Occlusion: Description of a Consecutive Case Series from Southern Portugal. J Neurosci Rural Pract. 2022;13(1):151-4. DOI:10.1055/s-0041-1741485
21. Ikramuddin SS, Coburn JA, Ramezani S, Streib C. Artery of Percheron Infarction: Clinical Presentation and Outcomes. Neurol Clin Pract. 2024;14(2):e200266. DOI:10.1212/CPJ.0000000000200266
22. Gusev EI, Martynov MY, Nikonov AA, et al. Non-immunogenic recombinant staphylokinase versus alteplase for patients with acute ischaemic stroke 4·5 h after symptom onset in Russia (FRIDA): a randomised, open label, multicentre, parallel-group, non-inferiority trial. Lancet Neurol. 2021;20(9):721-8. DOI:10.1016/S1474-4422(21)00210-6
23. Кулеш А.А., Сыромятникова Л.И., Крапивин С. Опыт применения неиммуногенной стафилокиназы для внутривенного тромболизиса при ишемическом инсульте: анализ данных госпитального регистра. Медицинский Совет. 2023;17(3):24-9 [Kulesh AA, Syromyatnikova LI, Krapivin S. Experience with non-immunogenic staphylokinase for intravenous thrombolysis in ischemic stroke: analysis of hospital registry data. Meditsinskiy Sovet. 2023;17(3):24-9 (in Russian)]. DOI:10.21518/ms2023-057
24. Кулеш А.А., Сыромятникова Л.И., Крапивин С., Астанин П.В. Сравнение эффективности применения неиммуногенной стафилокиназы и алтеплазы для внутривенного тромболизиса при ишемическом инсульте: анализ данных госпитального регистра. Журнал неврологии и психиатрии им. С.С. Корсакова. 2024;124(7):139-44 [Kulesh AA, Syromyatnikova LI, Krapivin S, Astanin PV. Comparison of the effectiveness of non-immunogenic staphylokinase and alteplase for intravenous thrombolysis in ischemic stroke: analysis of hospital registry data. SS Korsakov Journal of Neurology and Psychiatry. 2024;124(7):139-44 (in Russian)]. DOI:10.17116/jnevro2024124071139
25. Çetin FE, Kumral E, Dere B. The Clinical and Cognitive Spectrum of Artery of Percheron Infarction: 1-Year Follow-Up. Can J Neurol Sci. 2022;49(6):774-80. DOI:10.1017/cjn.2021.212

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1. Huff JS. Stroke mimics and chameleons. Emerg Med Clin North Am. 2002;20(3):583-95. DOI:10.1016/s0733-8627(02)00012-3
2. Kulesh AA, Demin DA, Vinogradov OI. Differential diagnosis of ischemic stroke in the arteries of the vertebrobasilar system. Neurology, Neuropsychiatry, Psychosomatics. 2023;15(5):13-9 (in Russian). DOI:10.14412/2074-2711-2023-5-13-1
3. Titov AV, Mozgovaya OE. Thalamic Ischemic Stroke as a Result of the Occlusion of the Artery of Persheron. Journal of Radiology and Nuclear Medicine. 2020;101(2):121-5 (in Russian). DOI:10.20862/0042-4676-2020-101-2-121-125
4. Ciacciarelli A, Francalanza I, Giammello F, et al. Prevalence, clinical features, and radiological pattern of artery of Percheron infarction: a challenging diagnosis. Neurol Sci. 2023;44(7):2413-9. DOI:10.1007/s10072-023-06681-4
5. Percheron G. The anatomy of the arterial supply of the human thalamus and its use for the interpretation of the thalamic vascular pathology. Z Neurol.
1973;205(1):1-13. DOI:10.1007/BF00315956
6. Lazzaro NA, Wright B, Castillo M, et al. Artery of percheron infarction: imaging patterns and clinical spectrum. AJNR Am J Neuroradiol. 2010;31(7):1283-9.
7. Kichloo A, Jamal SM, Zain EA, et al. Artery of Percheron Infarction: A Short Review. J Investig Med High Impact Case Rep. 2019;7:2324709619867355. DOI:10.1177/2324709619867355
8. Atallah O, Almealawy YF, Alabide AS, et al. Navigating the clinical landscape of artery of Percheron infarction: A systematic review. eNeurologicalSci. 2024;37:100521. DOI:10.1016/j.ensci.2024.100521
9. Aaron S, Mani S, Prabhakar AT, et al. Stuck with a drowsy patient, evoke the Percheron. Neurol India. 2015;63(4):542-7. DOI:10.4103/0028-3886.162045
10. Arauz A, Patiño-Rodríguez HM, Vargas-González JC, et al. Clinical spectrum of artery of Percheron infarct: clinical-radiological correlations. J Stroke Cerebrovasc Dis. 2014;23(5):1083-8. DOI:10.1016/j.jstrokecerebrovasdis.2013.09.011
11. Agarwal N, Chaudhari A, Hansberry DR, Prestigiacomo CJ. Redefining thalamic vascularization vicariously through gerald percheron: a historical vignette. World Neurosurg. 2014;81(1):198-201. DOI:10.1016/j.wneu.2013.01.030
12. Jumean K, Arqoub AA, Al Hadidi MA, et al. Bilateral thalamic stroke due to occlusion of the artery of Percheron in a patient with a patent foramen ovale. J Nat Sci Biol Med. 2016;7(1):109-12. DOI:10.4103/0976-9668.175108
13. Zhang B, Wang X, Gang C, Wang J. Acute percheron infarction: a precision learning. BMC Neurol. 2022;22(1):207. DOI:10.1186/s12883-022-02735-w
14. Qaiser A, Lozano D, Liquigli N, et al. CT Perfusion Imaging Guides Clinical Decision-Making in a Case of Thalamic Stroke: A Case Report. Cureus. 2023;15(9):e44846.
15. Taydas O, Ogul Y, Ogul H. Association with clinic risk factors of Percheron artery infarction and magnetic resonance imaging involvement patterns. Acta Neurol Belg. 2022;122(2):411-5. DOI:10.1007/s13760-021-01697-z
16. Sparaco M, Ciolli L, Zini A. Posterior circulation ischaemic stroke-a review part I: anatomy, aetiology and clinical presentations. Neurol Sci. 2019;40(10):1995-2006. DOI:10.1007/s10072-019-03977-2
17. Van den Bergh WM, van der Schaaf I, van Gijn J. The spectrum of presentations of venous infarction caused by deep cerebral vein thrombosis. Neurology.
2005;65(2):192-6. DOI:10.1212/01.wnl.0000179677.84785.63
18. Kalita J, Sachan A, Dubey AK, et al. A clinico-radiological study of deep cerebral venous thrombosis. Neuroradiology. 2022;64(10):1951-60. DOI:10.1007/s00234-022-02938-5
19. Goyal S, Murumkar V, Kulanthaivelu K, et al. DC-CRP: Deep Cerebral Venous Thrombosis, Clinicoradiological Profile, and Treatment Outcome in Indian Population-A Tertiary Care Experience. J Assoc Physicians India. 2024;72(10):38-44. DOI:10.59556/japi.72.0610
20. Macedo M, Reis D, Cerullo G, et al. Stroke due to Percheron Artery Occlusion: Description of a Consecutive Case Series from Southern Portugal. J Neurosci Rural Pract. 2022;13(1):151-4. DOI:10.1055/s-0041-1741485
21. Ikramuddin SS, Coburn JA, Ramezani S, Streib C. Artery of Percheron Infarction: Clinical Presentation and Outcomes. Neurol Clin Pract. 2024;14(2):e200266. DOI:10.1212/CPJ.0000000000200266
22. Gusev EI, Martynov MY, Nikonov AA, et al. Non-immunogenic recombinant staphylokinase versus alteplase for patients with acute ischaemic stroke 4·5 h after symptom onset in Russia (FRIDA): a randomised, open label, multicentre, parallel-group, non-inferiority trial. Lancet Neurol. 2021;20(9):721-8. DOI:10.1016/S1474-4422(21)00210-6
23. Kulesh AA, Syromyatnikova LI, Krapivin S. Experience with non-immunogenic staphylokinase for intravenous thrombolysis in ischemic stroke: analysis of hospital registry data. Meditsinskiy Sovet. 2023;17(3):24-9 (in Russian). DOI:10.21518/ms2023-057
24. Kulesh AA, Syromyatnikova LI, Krapivin S, Astanin PV. Comparison of the effectiveness of non-immunogenic staphylokinase and alteplase for intravenous thrombolysis in ischemic stroke: analysis of hospital registry data. SS Korsakov Journal of Neurology and Psychiatry. 2024;124(7):139-44 (in Russian). DOI:10.17116/jnevro2024124071139
25. Çetin FE, Kumral E, Dere B. The Clinical and Cognitive Spectrum of Artery of Percheron Infarction: 1-Year Follow-Up. Can J Neurol Sci. 2022;49(6):774-80. DOI:10.1017/cjn.2021.212

Авторы

А.А. Кулеш*^1,2, Д.А. Дёмин³

¹ФГБОУ ВО «Пермский государственный медицинский университет им. акад. Е.А. Вагнера» Минздрава России, Пермь, Россия;
²ГАУЗ ПК «Городская клиническая больница №4», Пермь, Россия;
³ФГБУ «Федеральный центр сердечно-сосудистой хирургии» Минздрава России, Астрахань, Россия
*aleksey.kulesh@gmail.com

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Aleksey A. Kulesh*^1,2, Dmitry A. Demin³

¹Vagner Perm State Medical University, Perm, Russia;
²City Clinical Hospital No. 4, Perm, Russia;
³Federal Center for Cardiovascular Surgery, Astrakhan, Russia
*aleksey.kulesh@gmail.com

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