@article {Lazzaro1283, author = {N.A. Lazzaro and B. Wright and M. Castillo and N.J. Fischbein and C.M. Glastonbury and P.G. Hildenbrand and R.H. Wiggins and E.P. Quigley and A.G. Osborn}, title = {Artery of Percheron Infarction: Imaging Patterns and Clinical Spectrum}, volume = {31}, number = {7}, pages = {1283--1289}, year = {2010}, doi = {10.3174/ajnr.A2044}, publisher = {American Journal of Neuroradiology}, abstract = {BACKGROUND AND PURPOSE: Occlusion of the AOP results in a characteristic pattern of ischemia: bilateral paramedian thalamus with or without midbrain involvement. Although the classic imaging findings are often recognized, only a few small case series and isolated cases of AOP infarction have been reported. The purpose of this study was to characterize the complete imaging spectrum of AOP infarction on the basis of a large series of cases obtained from multiple institutions. MATERIALS AND METHODS: Imaging and clinical data of 37 patients with AOP infarction from 2000 to 2009 were reviewed retrospectively. The primary imaging criterion for inclusion was an abnormal signal intensity on MR imaging and/or hypoattenuation on CT involving distinct arterial zones of the bilateral paramedian thalami with or without rostral midbrain involvement. Patients were excluded if there was a neoplastic, infectious, or inflammatory etiology. RESULTS: We identified 4 ischemic patterns of AOP infarction: 1) bilateral paramedian thalamic with midbrain (43\%), 2) bilateral paramedian thalamic without midbrain (38\%), 3) bilateral paramedian thalamic with anterior thalamus and midbrain (14\%), and 4) bilateral paramedian thalamic with anterior thalamus without midbrain (5\%). A previously unreported finding (the {\textquotedblleft}V{\textquotedblright} sign) on FLAIR and DWI sequences was identified in 67\% of cases of AOP infarction with midbrain involvement and supports the diagnosis when present. CONCLUSIONS: The 4 distinct patterns of ischemia identified in our large case series, along with the midbrain V sign, should improve recognition of AOP infarction and assist with the neurologic evaluation and management of patients with thalamic strokes. AFatrial fibrillationAICAanterior inferior cerebellar arteryangioangiographyAOPartery of PercheronCADcoronary artery diseaseCardAbncardiac abnormalities (miscellaneous non-valvular)CEcardiac embolismCHFcongestive heart failureCT perfCT perfusionCTACT angiographyCVA-Pprevious cerebrovascular accidentDMdiabetes mellitusDVIdeep venous thrombusDWIdiffusion-weighted imagingEtOHheavy drinkingFLAIRfluid-attenuated inversion recoveryFMDfibromuscular dysplasiaHHChyperhomocysteinemiaHLhyperlipidemiaHTNhypertensionH/ohistory ofICHintracranial hemorrhageINOinternuclear ophthalmoplegiaLleftLAAlarge artery atherosclerosis (includes large artery thrombosis and artery-to-artery embolism)LVleft ventricularLVADleft ventricular assist deviceMCAmiddle cerebral arteryMRAMR angiographyMRI or MRMR imagingOCPoral contraceptive pillODCstroke of other determined causeP1first segment of the PCAP2second segment of PCAPCAposterior cerebral arteryPcomAposterior communicating arteryPFOpatent foramen ovalePICAposterior inferior cerebellar arteryRrightSCAsuperior cerebellar arteryS/pstatus postSVOsmall vessel occlusionTIA-Pprevious transient ischemic attackTobtobacco smokerUNDstroke of undetermined causeVAvertebral arteryValvAbnvalvular abnormalitiesYyes}, issn = {0195-6108}, URL = {https://www.ajnr.org/content/31/7/1283}, eprint = {https://www.ajnr.org/content/31/7/1283.full.pdf}, journal = {American Journal of Neuroradiology} }