Presentation
Sudden onset bilateral weakness (right > left) and aphasia. Previous CVA.
Patient Data
No acute loss of grey white matter differentiation. No hemorrhage or surface collection. No mass effect or midline shift. Ventricle and sulcal pattern is within normal limits for the patients age. Incidental mega cisterna magna (normal variant).
ASPECTS 10.
Small hyperdense right A2 on the thin data set.
Abruptly truncated and occluded distal A2 azygos anterior cerebral artery. Remaining major cerebral arteries are patent. Carotid and vertebral arteries are patent. Bovine arch with common origin of brachiocephalic trunk and left CCA.
Perfusion abnormality in the paramedian aspects of the frontoparietal lobes bilaterally in the anterior cerebral artery territory demonstrating ischemic core and surrounding penumbra. Estimated valuse of core infarct 71 ml, penumbra 24 ml, ratio 4.0.
Azygos ACA confirmed.
Case Discussion
Nice case example of a azygos ACA (normal variant) occlusion causing bilateral ACA territory infarcts.
The patient underwent mechanical thrombectomy (endovascular clot retrieval, ECR) achieving a TICI 2c result.