Bilateral anterior cerebral artery territory infarction due to ruptured anterior communicating artery aneurysm

Case contributed by Dr Bruno Lorensini

Presentation

Decreased level of consciousness. GCS 6.

Patient Data

Age: 54
Gender: Male

Hyperdensity in all basal cisterns, bilateral sylvian fissures, inter-hemispheric fissure and fourth ventricle due to subarachnoid haemorrhage.

Hypoattenuation bilaterally in the frontal lobes and left hemisphere of the cerebellum, suggesting ischemia.

Selective catheterization of the left internal carotid artery, visualize ACOM saccular cerebral aneurysm (berry aneurysm), with narrow neck (06 mm).

Metallic artifact due to coil.

Hyperattenuation in the basal cisterns, inter-hemispheric fissures related subarachnoid hemorrhage.

Increased hypoattenuation in bilateral frontal lobes and left hemisphere to the cerebellum compared to prior examination. Hypoattenuation in vascular territory in the anterior cerebral artery due to ischemia.

Case Discussion

Bilateral ACA territory infarction is an uncommon condition. Literature describes that usually due to vasospasm that occurs as a complication of subarachnoid haemorrhage, most commonly by rupture of aneurysms of the ACOM or distal ACAs 1.

Other causes of stroke within the ACA bilaterally are described, as tumor and thrombosis / embolism in patients with abnormality in the anterior part of the circle of Willis (one side ACA hypoplastic and branches of ACA contralateral supplying both lobes), but both are less frequent than the case presented.

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Case information

rID: 39847
Case created: 23rd Sep 2015
Last edited: 22nd Aug 2016
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Inclusion in quiz mode: Included

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