Presentation
Patient admitted to ED with sudden onset of right-sided hemiplegia, hemianesthesia and left-sided hemianopia.
Patient Data
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 extra-axial fluid collection or mass lesion. There is no evidence of acute transcortical infarction or hyperdense vessel. No transtentorial herniation or midline shift. No abnormal calcifications present.
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 extra-axial 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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