Embolic shower and recurrent artery of Heubner infarct

Case contributed by Angel Donato
Diagnosis almost certain


Left hemispheric seizure with secondary generalization. ? seizure focus.

Patient Data

Age: 80 years
Gender: Male

Examination demonstrates an acute stroke with prominent diffusion signal abnormality and matching diffusion restriction, affecting the right recurrent artery of Heubner involving the head of the right caudate nucleus, right anterior cerebral artery pericallosal branch along the right cingulate gyrus and medial right frontal cortex, right middle cerebral artery superior division involving supra Sylvian lateral frontal and parietal cortex, infarction involving the splenium of the corpus callosum to the left of midline, infarct involving the medial left temporal lobe hippocampal and parahippocampal hippocampal gyri.​

Case Discussion

The MRI brain showed multiple embolic strokes also known as an embolic shower. Embolic stroke may arise from cardiac sources such as atrial fibrillation (which is considered the major source of cardioembolic stroke), thrombus formation in an enlarged left cardiac chamber (aneurysm), in the presence of right-to-left shunt (paradoxical embolism), from valvular surface releasing abnormal materials (endocarditis) and thrombus from the vessel supplying the brain ( Internal carotid artery).

Recurrent artery of Heubner (RAH) is the largest perforating branch of the proximal anterior cerebral artery (ACA), arising from the proximal A2 in 90% of cases, and from the distal A1 in 10% of cases. It is single in 96.22 % of cases, double in 2.38 % of cases and triple in 0.14 % of cases. Postoperative infarctions following surgical repair of the anterior communicating artery (ACOM) aneurysms is very frequently.

Recurrent artery of Heubner (RAH) supplies the head of the caudate nucleus, paraterminal gyrus, anterior portion of the lentiform nucleus and anterior limb of the internal capsule.

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