Quadriparesis with bilateral anterior cerebral artery infarction following subarachnoid haemorrhage due to rupture of an anterior communicating artery aneurysm: A case report with literature review

IF 1.3 Q4 CLINICAL NEUROLOGY
Zain Saleh, Farhat Abbas, Ahtesham Khizar, Bakht Nawaz
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Abstract

Background

Anterior cerebral artery (ACA) territory infarctions are relatively rare, accounting for 0.3 % to 4.4 % of stroke cases, with bilateral occurrences being even rarer. These infarctions can lead to quadriplegia/paresis. Bilateral ACA territory infarctions are possibly caused by vasospasm due to subarachnoid haemorrhage (SAH) from ruptured anterior communicating artery (ACoA) aneurysms or thrombosis in the presence of a rudimentary contralateral artery. ACoA aneurysm with quadriparesis is extremely unusual, with this being only the second recorded occurrence and the youngest reported. Overall, understanding the mechanisms and consequences of ACA territory infarctions, especially bilateral occurrences, remains crucial for effective diagnosis and management of such rare but serious neurological events.

Case Presentation

A 35-year-old male, previously healthy, presented with quadriparesis and an ACoA aneurysm. Initially experiencing a headache and brief loss of consciousness, he later developed right foot drop and progressive right-sided weakness, leading to altered consciousness. Subsequent imaging revealed SAH consistent with the aneurysm and also bilateral ACA territory infractions. Upon referral for further management, he presented with intact higher mental functions but motor deficits in the upper and lower limbs. Imaging and assessments confirmed the diagnosis, prompting a decision for craniotomy and clipping. Postoperatively, the patient showed improvement, with enhanced power in both upper limbs at one-month follow-up.

Conclusion

Bilateral ACA territory infarction is unusual, and the symptoms are not yet well understood. ACoA aneurysm with quadriparesis is extremely unusual. Understanding the mechanics and clinical consequences of bilateral ACA territory infarctions is critical for early detection and management.
前交通动脉瘤破裂导致蛛网膜下腔出血后双侧大脑前动脉梗死并发四肢瘫痪:病例报告及文献综述
脑后动脉(ACA)区域梗死相对罕见,约占脑卒中病例的0.3% - 4.4%,双侧发生更为罕见。这些梗死可导致四肢瘫痪/麻痹。双侧ACA区域梗死可能是由前交通动脉(ACoA)动脉瘤破裂引起的蛛网膜下腔出血(SAH)引起的血管痉挛或对侧动脉存在基础血栓形成引起的。ACoA动脉瘤合并四肢瘫是非常罕见的,这是仅有的第二例记录,也是最年轻的报道。总的来说,了解ACA区域梗死的机制和后果,特别是双侧发生,对于有效诊断和管理这种罕见但严重的神经系统事件仍然至关重要。病例介绍:一名35岁男性,既往健康,表现为四肢麻痹和ACoA动脉瘤。患者最初有头痛和短暂的意识丧失,后来出现右脚下垂和进行性右侧无力,导致意识改变。随后的影像学显示SAH与动脉瘤一致,也有双侧ACA侵犯。转介进一步治疗后,他表现出完整的高级精神功能,但上肢和下肢运动缺陷。影像学和评估证实了诊断,促使决定开颅和夹。术后,患者表现出改善,在一个月的随访中,患者双上肢力量增强。结论双侧ACA区域梗死是一种罕见的疾病,其症状尚不清楚。ACoA动脉瘤伴四肢瘫极为罕见。了解双侧ACA区域梗死的机制和临床后果对于早期发现和治疗至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Brain Hemorrhages
Brain Hemorrhages Medicine-Surgery
CiteScore
2.90
自引率
0.00%
发文量
52
审稿时长
22 days
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