Artery of percheron infarct - a rare thalamic stroke

Thalamic infarcts can occur in about 15 of all stroke patients mostly presenting as sensory disturbances in one half of the body with or without hemiparesis. Large thalamic infarcts causing coma and mortality are rare. We report a rare case of stroke in young presenting as coma initially and subsequently found to have bilateral medial thalamic infarct due to Artery of Percheron occlusion on MRI of the brain. A 28 year old male, nonhypertensive, non- diabetic with no prior heart disease admitted in medical ward with altered sensorium for few hours with no previous episodes or illness. On examination he had no focal deficit except for altered sensorium. Even though there are numerous causes for coma, early imaging in this patient revealed the cause of coma as stroke due to bilateral thalamic infarct. The patient regained the consciousness one day later and found to have other features of bilateral thalamic infarct such as vertical gaze palsy, loss of accommodation , memory disturbances . On further investigations he was confirmed to have artery of percheron infarct as well as hyperhomocysteinemia.The patient improved in about a week and discharged with recent memory disturbance and vertical gaze palsy. This patient is presented for the rare cause of strokehyperhomocysteinemia with thalamic artery of percheron infarct and emphasized the need for early imaging.