Etiology of Bilateral Thalamic Infarction: Identifying Occlusion of the Percher Artery.

Bilateral thalamic infarction denotes ischaemic-hypoxic necrosis of cerebral tissue in both thalamic regions due to compromised blood supply, constituting a distinct subtype of ischaemic cerebrovascular disease. Its clinical presentation is complex yet characteristic. Core manifestations include acute impaired consciousness, marked cognitive decline with memory deficits, vertical gaze palsy, and somnolence. Imaging studies reveal that the primary pathogenesis involves vascular anomalies in the perforating arteries supplying the bilateral parahypothalamic midline regions. These arteries frequently originate from a common trunk, often derived from the P1 segment of the unilateral posterior cerebral artery. Occlusion of this common trunk can result in bilateral symmetrical infarction. This paper reports a case of bilateral thalamic infarction, emphasising that early recognition of the characteristic clinical-imaging syndrome is crucial for definitive diagnosis. Understanding the vascular mechanism underlying bilateral thalamic infarction enables early anticoagulant and thrombolytic therapy to preserve reversible brain tissue.