Abstract
We present a rare case of bilateral anterior cerebral artery (ACA) territory infarction with akinetic mutism, quadriparesis and frontal lobe release signs along with limbic dysfunction mimicking a basilar artery thrombosis. The etiology was thrombosis of the anterior communicating artery with propagation or embolism of the thrombus to both A2 segments of the anterior cerebral artery and restricted or absent blood flow in the branches arising from the A2 and A3 segments causing extensive infarction. We also aim to review the anatomy of the ACA to understand localization of lesions.
Highlights
Bilateral anterior cerebral artery vascular territory infarction is very rare
There was no evidence of any early CT changes suggesting an infarction or intracerebral hemorrhage or subarachnoid hemorrhage
There was no evidence of sinus venous thrombosis or intracerebral or subarachnoid hemorrhage on the second non-contract CT as well
Summary
Bilateral anterior cerebral artery vascular territory infarction is very rare. We present an elderly male with bilateral infarction due to aneurysm of the anterior communicating artery. A 76-year-old healthy male and a heavy smoker, presented with acute onset loss of responsiveness. On clinical evaluation he was mute, non-responsive, quadriparesis with decorticate posturing and spontaneous eye opening. A repeat scan at 17 hours showed bilaterally dense A2 segment with acute infarction of bilateral anterior cerebral artery territory. The A2 segment of the right ACA was opacified normally (possible interval recanalization) and the A2 segment of the left ACA was not visualized Both internal carotid arteries and middle cerebral arteries were normal in course and caliber.
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