Bilateral cerebral infarction associated with severe arteriosclerosis
in the A1 segment: a case report

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Abstract

Large artery atherosclerosis and cardioembolism are the two major subtypes of ischemic stroke. We herein describe a 75-year-old man with acute complete cerebral infarction in the typical territories of the bilateral anterior cerebral artery (ACA) and left middle cerebral artery. Brain magnetic resonance angiography showed that the right A1 segment of the ACA was affected by severe arteriosclerosis and that the right ACA other than the A1 segment was compensated by the left ACA through the anterior communicating artery. Acute cardioembolism only occluded the left anterior circulation but simultaneously blocked the right ACA due to decompensation. We presume that the bilateral cerebral infarctions were caused by chronic atherosclerosis and acute cardioembolism.

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Anterior cerebral artery infarction: stroke mechanism and clinical-imaging study in 100 patients.

Y Kang, John Kim (2008)

Stroke mechanisms and clinical features of anterior cerebral artery (ACA) territory infarction have rarely been investigated using MRI. To verify stroke mechanisms and to make clinical imaging correlation. Clinical, MRI, and angiographic findings of 100 consecutive patients with ACA infarction were studied. Motor dysfunction (n = 91) was the most common symptom, and severe motor dysfunction was related to supplementary motor area/paracentral lobule involvement (p = 0.016). Hypobulia/apathy (n = 43) was related to involvement of frontal pole (p = 0.002), corpus callosum/cingulate gyrus (p = 0.003), and superior frontal gyrus (p < 0.001), and occurred more frequently in patients with bilateral lesions followed by left lesions. Urinary incontinence (n = 30) was not related to any specific lesion locations. Grasp reflex (n = 25) was related to corpus callosum involvement (p = 0.035). Angiographic (mostly MR angiography) results showed that 68 patients had local ACA atherosclerosis, most often at A2 segment. The stroke mechanisms included cardiogenic embolism in 10, internal carotid artery-ACA embolism in 6, and ACA atherosclerosis in 61 patients. In the latter group, detailed stroke mechanisms included local branch occlusion (n = 20), in situ thrombotic occlusion (n = 20), artery-to-artery embolism (n = 12), and a combination (n = 9). Patients with intrinsic ACA disease more often had hypobulia (p = 0.077) and corpus callosal involvement (p = 0.016) than those with embolism either from the internal carotid artery or the heart. Anterior cerebral artery (ACA) atherosclerosis is the most important stroke etiology in our population, causing infarction with various mechanisms. Topographic lesion patterns and consequent clinical features of ACA infarction are determined by diverse pathogenic mechanisms and the status of collateral circulation.

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Variations in the configuration of the circle of Willis.

Late Dewan, Abhay Kapoor, Gillian Singh (2008)

Brains were obtained from 1000 medicolegal autopsy subjects of varying ages. The circle of Wills was examined at the base of the brain. The cerebral vessels were observed with regards to their origin, caliber and typical configuration. Variations were noted and grouped into different categories. Out of 1000 specimens examined, 452 (45.2%) conformed to the typical pattern. In the rest of the specimens (54.8%) there were variations in the circulus arteriosus. The circle was deficient in 32 (3.2%). The anterior cerebral artery was absent in 0.4%; hypoplastic in 1.7%; duplicated in 2.6%; triple in 2.3% and single in 0.9%. The anterior communicating artery was absent in 1.8%, duplicate in 10%, triplicate in 1.2% and plexiform in 0.4%. Multiplication of posterior cerebral artery was observed in 2.4% cases while it was hypoplastic in 10.6% brains. Posterior communicating artery was absent in 1% and hypoplastic in 13.2%. Seventy-four brains (7.4%) had multiple variations. Intracranial saccular aneurysm was present in 10 (1%). These figures are compared with the available literature. Persistence of some embryonic vessel that normally disappear, disappearance of vessels that would normally persist or sprouting of new vessels due to hemodynamic and genetic factors are the usual causes for such anomalies. These variations are discussed with regard to development and other hemodynamic factors.

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Cardioembolic stroke: an update.

Charles J Ferro (2003)

Embolism of cardiac origin accounts for about one fifth of ischaemic strokes. Strokes due to cardioembolism are in general severe and prone to early recurrence. The risk of long term recurrence and mortality are high after a cardioembolic stroke. Cardioembolism can be reliably predicted on clinical grounds but is difficult to document. MRI, transcranial doppler, echocardiogram, Holter monitoring, and electrophysiological studies increase our ability to identify the source of cardioembolism. Non-valvular atrial fibrillation is the commonest cause of cardioembolic stroke. Despite its enormous preventive potential, continuous oral anticoagulation is prescribed for less than half of patients with atrial fibrillation who have risk factors for cardioembolism and no contraindications for anticoagulation. Alternatives to oral anticoagulation in this setting include safer and easier to use antithrombotic drugs and definitive treatment of atrial fibrillation. Available evidence does not support routine immediate anticoagulation of acute cardioembolic stroke.

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Author and article information

Journal

Journal ID (nlm-ta): J Int Med Res

Journal ID (iso-abbrev): J. Int. Med. Res

Journal ID (publisher-id): IMR

Journal ID (hwp): spimr

Title: The Journal of International Medical Research

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 0300-0605

ISSN (Electronic): 1473-2300

Publication date (Electronic): 14 February 2019

Publication date (Print): March 2019

Volume: 47

Issue: 3

Pages: 1373-1377

Affiliations

[1 ]Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

[2 ]Department of Neurosurgery Intensive Care Unit, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

Author notes

[*]

These authors contributed equally to this work.

[*]Wenli Sheng, Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhong Shan Er Lu, Guangzhou 510080, China. Email: shengwl@ 123456mail.sysu.edu.cn

Author information

Wenli Sheng https://orcid.org/0000-0001-6867-371X

Article

Publisher ID: 10.1177_0300060519828930

DOI: 10.1177/0300060519828930

PMC ID: 6421377

PubMed ID: 30760064

SO-VID: ed9e5954-5b66-4ee2-923e-12834e0b9af4

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Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 4 October 2018

Date accepted : 15 January 2019

Funding

Funded by: National Natural Science Foundation of China, FundRef https://doi.org/10.13039/501100001809;

Award ID: Grant no. 81471180 and Grant no. 81671132

Bilateral cerebral infarction associated with severe arteriosclerosis in the A1 segment: a case report

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International Journal of Medicine and Medical Research

Most cited references 10

Anterior cerebral artery infarction: stroke mechanism and clinical-imaging study in 100 patients.

Variations in the configuration of the circle of Willis.

Cardioembolic stroke: an update.

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