Anterior choroidal artery infarct

Case contributed by Dr Arkadi Tadevosyan


Patient admitted to ED with sudden onset of right-sided hemiplegia, hemianesthesia and left-sided hemianopia.

Patient Data

Age: 60
Gender: Male

Initial CT scan did not show any acute findings. Cortical sulci and basilar cisterns are
normal in size and configuration, ventricles are unremarkable. There is no intra or extraaxial fluid collection or mass lesion. There is no evidence of acute transcortical infarction or hyperdense vessel. There is no transtentorial herniation or midline shift. No abnormal calcifications are present.


48 hours later

There is subtle hypodensity at the right posterior limb of internal capsule and small hypodense foci at right mesial temporal lobe mostly consistent with anterior choroidal arterial(AChA) territory infarction.

No intra or extraaxial blood collection, CSF spaces are normal, no midline shift or hydrocephalus.

Case Discussion

Patient has undergone a cervical duplex ultrasound scan and right-sided internal carotid artery atherosclerotic disease was identified.

Anterior choroidal artery syndrome is a rare entity characterised by the triad of:

  • hemiplegia
  • hemianaesthesia
  • contralateral hemianopia

This is the result of the cerebral infarction in the anterior choroidal artery territory, which in this case the patient has. Anterior choroid artery vascular territory is divided into:

  • cisternal segment
    • hippocampus and amygdala
    • optic tract
    • lateral geniculate nucleus and lateral aspect of the thalamus
    • posterior limb of the internal capsule
    • lateral aspect of the midbrain
  • intraventricular segment
    • choroid plexus of the anterior part of the temporal horns of the lateral ventricles


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Case information

rID: 55106
Published: 20th Aug 2017
Last edited: 6th Nov 2017
Inclusion in quiz mode: Included

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