Objective:

To enhance recognition and understanding of artery of Percheron (AOP) infarction with a unilateral fetal-type posterior cerebral artery (fPCA).

Approach:

• Case Presentation: Three cases of AOP infarction with unilateral fPCA were presented, detailing clinical features, imaging findings, treatment strategies, and outcomes.

Key Findings:

• All patients presented with acute impairment of consciousness and pupillary dysfunction.
• Neuroimaging (MRI and CT) revealed bilateral paramedian thalamic infarctions.
• Cerebrovascular studies confirmed a unilateral fPCA in all cases.
• Outcomes varied: Cases 1 and 3 had poor outcomes, while Case 2 showed neurological improvement.

Interpretation:

AOP infarction should be suspected in patients with acute consciousness impairment and pupillary abnormalities, especially in the absence of limb weakness. The presence of a unilateral fPCA is a critical diagnostic clue.

Limitations:

• The study is based on a small number of cases.
• Outcomes may not be generalizable due to variability in patient conditions and treatments.

Conclusion:

Early neuroimaging, particularly MRI, is crucial for timely diagnosis of AOP infarction.