Presentation
A case of metastatic ampullary carcinoma to abdominal lymph node presented with a headache.
Patient Data
Left occipital cortical and sub-cortical ill-defined area of hypodensity with no significant post contrast enhancement likely representing ischemic insult in the left posterior cerebral artery territory.
Left occipital cortical and subcortical ill-defined area of abnormal low signal intensity in T1, bright signal intensity on T2 and FLAIR weighted images is noted with predominantly marginal and gyral enhancement in post contrast study (luxury perfusion) and evidence of diffusion restriction. Similar foci of abnormal signal intensity and abnormal diffusion restriction are noted at the left temporo-occipital region. MRA showed complete occlusion of the left internal carotid artery with fetal origin of the left posterior cerebral artery.
Doppler examination of the left internal carotid artery shows significant stenosis of the artery from its origin at the carotid bifurcation by atheromatous plaques with superadded thrombus.
Case Discussion
Left posterior cerebral artery territory embolic infarction secondary to left internal carotid artery thrombus with a fetal origin of the left posterior cerebral artery, which is the most common congenital variant of the circle of Willis.
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