Persistent blepharospasm and bradyphrenia following Artery of Percheron infarction

Abstract

Infarctions of the artery of Percheron are a rare clinical event, primarily presenting as bilateral thalamic infarcts with varying manifestations. We report an unusual case of a 50-year-old male who presented with sudden loss of consciousness, afebrile hypertension, and a Glasgow Coma Scale (GCS) score of 7/15. Initial laboratory findings were unremarkable, but further investigations revealed bilateral thalamic infarcts on MRI. The patient was managed for stroke with antiplatelet therapy and supportive treatment. He was discharged after improvement in his clinical status; however, he continued to experience persistent bradyphrenia and blepharospasm. During a follow-up visit, the patient was administered a Botox injection, which improved the blepharospasm, emphasizing on the importance of palliative care in addressing long-term sequelae of stroke. This patient exhibited the rare combination of bradyphrenia and blepharospasm. MRI is the investigation of choice in diagnosing AOP infarcts, but timely clinical evaluation is essential to minimize the risk of persistent long-term symptoms. This case of an atypical presentation of blepharospasm and bradyphrenia associated with an AOP infarct highlights the need for further research into the diverse clinical manifestations and underlying mechanisms of these infarctions.