Introduction:

Percheron Syndrome is an infrequent entity that is difficult to determine clinically, caused by the occlusion of the Percheron artery.

Case presentation:

We present a 71-year-old male patient admitted to the emergency department: obtunded, with dysarthria, left hemiparesis, bilateral Babinsky's sign, right palpebral ptosis, with exotropia, total adduction limitation of the right eye and partial adduction of the right eye. abduction of the left with impossibility of supraduction and infraduction of both eyes. Absent vertical oculocephalic reflex bilaterally and absent right horizontal. Anisochoric pupils, photomotor reflex absent in both eyes. The images obtained by Nuclear Magnetic Resonance (T1W, T2, T2-FLAIR and diffusion techniques) showed infarction of the Percheron artery. He remained hospitalized for 10 days, and evolved favorably.

Discussion.

Percheron Syndrome presents with a classic triad characterized by altered consciousness, cognitive impairment and paralysis of vertical gaze, to which is added hemiplegia, cerebellar ataxia and oculomotor deficit, if accompanied by mesencephalic lesions, producing a Thalamopeduncular Syndrome. The clinical suspicion of this pathology constitutes a challenge in medical practice, due to the infrequency of presentation, variability of neurological alterations and the difficulty offered by emergency imaging studies.

Conclusions.

We have described a rare entity that is difficult to determine clinically, in which the criteria for diagnosis are fundamentally imaging, with MRI being the choice. The evolution and prognosis will depend on the extent of the process, structures involved in addition to the diagnosis and timely treatment.

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