Bilateral anterior cerebral artery territory infarction due to ruptured anterior communicating artery aneurysm
Presentation
Decreased level of consciousness. GCS 6.
Patient Data
Hyperdensity in all basal cisterns, bilateral sylvian fissures, inter-hemispheric fissure and fourth ventricle due to subarachnoid hemorrhage .
Hypoattenuation bilaterally in the frontal lobes and left hemisphere of the cerebellum, suggesting ischemia.
Before embolization
Selective catheterization of the left internal carotid artery, visualize ACOM saccular cerebral aneurysm (berry aneurysm), with narrow neck (06 mm).
One day after embolization
Metallic artifact due to coil.
Hyperattenuation in the basal cisterns and inter-hemispheric fissure related to the subarachnoid hemorrhage.
Compared to prior examination, there is increased hypoattenuation in the bilateral frontal lobes and left hemisphere of the cerebellum. The hypoattenuation is due to ischemia in the vascular territory of the anterior cerebral artery .
Case Discussion
Bilateral ACA territory infarction is an uncommon condition. Literature describes that usually due to vasospasm that occurs as a complication of subarachnoid hemorrhage, 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.