Bilateral Cerebral Infarctions Secondary to Unilateral ICA Stenosis

Dhananjay Gupta, Karan Sharma, D. Thakkar, Nishchint Jain, Rajsrinivas Parthasarathy, Vipul Gupta
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Abstract

A 76-year-old diabetic man presented to us with complaints of sudden-onset right-sided weakness for the last 4 days. On evaluation, he was found to have right hemiparesis (Modified Medical Research Council grade 4-/5) along with left leg weakness (4+/5). Neuroimaging revealed acute infarcts in the right anterior cerebral artery (ACA) territory and left cerebral external watershed territory. Magnetic resonance (MR) angiogram of the brain showed a hypoplastic right A1-ACA with bilateral A2-ACA arising from the left A1-ACA (bi-hemispheric A1-ACA). MR angiogram of the neck revealed significant left internal carotid artery (ICA) origin stenosis. It was concluded that the origin of right A2-ACA from left ACA was the probable because of right ACA infarcts, along with left cerebral watershed infarcts (embolic phenomenon). This represents a very important variation, as in these cases, even a unilateral ICA stenosis can lead to bilateral ACA stroke and thus necessitates urgent revascularization.
继发于单侧ICA狭窄的双侧脑梗死
一位76岁的糖尿病患者向我们提出了最近4天突然发作的右侧无力的投诉。经评估,他被发现有右半瘫(修正医学研究委员会4-/5级)和左腿无力(4+/5级)。神经影像学显示右侧大脑前动脉(ACA)区域和左侧大脑外分水岭区域急性梗死。脑磁共振血管造影显示右侧A1-ACA发育不全,双侧A2-ACA源自左侧A1-ACA(双半球A1-ACA)。颈部磁共振血管造影显示明显的左颈内动脉(ICA)起源狭窄。结论右侧A2-ACA可能是由于右侧ACA梗死及左侧脑分水岭梗死(栓塞现象)所致。这是一个非常重要的变化,因为在这些病例中,即使单侧ICA狭窄也可能导致双侧ACA卒中,因此需要紧急血运重建。
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