Unveiling Rare Neurovascular Complexity; A Rare Bilateral Thalamic Infarction Case Report and Concise Literature Review

Abstract Background: Bilateral thalamic infarction resulting from the occlusion of the artery of Percheron (AOP) is an exceedingly rare cerebrovascular event. The intricate interplay between neurovascular anatomy, midbrain function, and clinical manifestations in such cases remains an area of clinical interest and exploration. Case Presentation: We present the case of a 48-year-old male farmer with a known history of Diabetes mellitus, who presented with diplopia, bilateral drooping of eyelids, and eventually loss of consciousness while working in the field. Initial management centered around suspected meningioencephalitis, given fever and unresponsiveness. Advanced evaluations, including brain MRI and MRA, led to the diagnosis of bilateral upper midbrain infarction involving the artery of Percheron. The patient's clinical course revealed an improvement in consciousness and responsiveness over three weeks of conservative management. Conclusions: This case report highlights the clinical rarity and diagnostic challenges associated with bilateral thalamic infarction due to AOP occlusion. The complex neurovascular interplay revealed by this case emphasizes the importance of precise diagnosis and tailored management in rare cerebrovascular events. The insights gained from this case contribute to a deeper understanding of the clinical impact and potential implications of such occurrences within the realm of stroke and cerebrovascular diseases.