A Drive Interrupted: Stroke of the Anterior Choroidal Artery – A Case Report

The anterior choroidal artery (AChA) is the most distal branch of the internal carotid artery (ICA) The ACHA is significant because it supplies important structures in the brain, including the optic tract, anterior portion of cerebral peduncle, lateral geniculate body, uncus, globus pallidus, posterior and superficial areas of the thalamus, and the retrolenticular and posterior portions of the internal capsule on the same side as the artery.  Isolated strokes involving the AChA are rare and can result in HHH Syndrome, consisting of contralateral hemiplegia, hemisensory loss, and homonymous hemianopia. Features which distinguish an AChA infarction from larger arterial pathology are lack of headache and lack of depressed level of consciousness in subacute infarction, and usually lack of aphasia acutely. The etiology remains controversial, with proposed mechanisms including cardioembolic, large-vessel atherosclerosis, dissection of the ICA, small-vessel occlusion, and cryptogenic causes. Herein, the authors report a case of an isolated AChA infarction resulting in a right-sided, pure motor hemiparesis with no sensory or vision loss, highly suggestive of cardioembolic origin, with the evaluation of the patient, and eventual treatment strategy.