Akinetic Mutism Following Bilateral Anterior Cerebral Artery Territory Infarction Due to Aneurysm: A Case Report

Abstract

Bilateral anterior cerebral artery (ACA) territory infarction is rare localization in stroke which should always prompt a search for an anterior communicating artery (ACoA) aneurysm. The common neurological manifestations are contralateral weakness predominate in the lower extremity, behaviour disturbance, motor inertia, muteness, incontinence, grasp reflex, diffuse rigidity, akinetic mutism. We describe a 38-year-old woman presented with a left sided hemiparesia and decrease of speech for last days. She was a smoker and morbide obese. She had no any diagnosed disease. Her neurological examination had weakness of left extremities affected leg more than the arm and akinetic mutism like as no spontaneously speech and move and grasp reflex. CT showed bilateral ACA infarction which included cingulate gyrus, the right side more than left and subarachnoid hemorrhage in the interhemispheric fissure. MRI angiography showed the appearance of AcoA aneurysm. We report a patient with bilateral infarction in the ACA which a rare localization and clinicians must be alert to exist AcoA aneurysm which may bleed, different symptoms and signs like as akinetic mutism, primitive reflexes.