A case of anterior cerebral artery A1 segment hypoplasia syndrome presenting with right lower limb monoplegia, abulia, and urinary incontinence

Lakhotia, Manoj; Pahadiya, Hans Raj; Prajapati, Gopal Raj; Choudhary, Ankita; Gandhi, Ronak; Jangid, Hemant

doi:10.4103/0976-3147.168438

Cited by 10 publications

(12 citation statements)

References 5 publications

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“… ○Posterior circulation strokes are more frequently encountered in patients with an ipsilateral hypoplastic vertebral artery ○Hypoplastic A1 segment may cause stroke symptoms, the so‐called A1 hypoplasia syndrome ○Pcom hypoplasia appears to be a risk in strokes even in the absence of vessel occlusion …”

Section: Significancementioning

confidence: 99%

Anomalies and Normal Variants of the Cerebral Arterial Supply: A Comprehensive Pictorial Review with a Proposed Workflow for Classification and Significance

Hakim

Gralla

Rozeik³

et al. 2017

Journal of Neuroimaging

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Cerebral arteries may exhibit a wide range of variation from normal anatomy, which can be incidentally discovered during imaging. Knowledge of such variants is crucial to differentiate them from pathologies, to understand the etiology of certain pathologies directly related to a vascular variant, and to depict the changes in collateral circulation in patients with certain variants. Detection of particular variants may lead to the discovery of other nonvascular or vascular anomalies, especially aneurysms, and may also affect planning of endovascular or neurosurgical interventions. In this review, we summarize the variants and anomalies of cerebral arteries seen on cross-sectional imaging classified by a morphological approach and categorize their significance from a clinical perspective. This structured review is intended to serve as a guide for daily use in clinical practice.

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Section: Significancementioning

confidence: 99%

Anomalies and Normal Variants of the Cerebral Arterial Supply: A Comprehensive Pictorial Review with a Proposed Workflow for Classification and Significance

Hakim

Gralla

Rozeik³

et al. 2017

Journal of Neuroimaging

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“…These variations are often asymptomatic or found incidentally, chronic headache is, however, a possible presentation in patients with arterial hypoplasia [9]. The A1 segment is a rare site for ischemic strokes, representing only 0.6-3% of all stroke etiologies [10]. The risk for ischemic stroke is further aggravated by the presence of such hypoplasia [5,10].…”

Section: Discussionmentioning

confidence: 99%

“…The A1 segment is a rare site for ischemic strokes, representing only 0.6-3% of all stroke etiologies [10]. The risk for ischemic stroke is further aggravated by the presence of such hypoplasia [5,10]. Furthermore, the presence of A1 hypoplasia increases the risk of aneurysm formation; a phenomenon that can be explained, in part, by alteration in ACoA complex hemodynamics [1].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the presence of such inverted hemodynamics around the ACoA complex may render the distal circulation more prone to ischemic stroke or aneurysm formation [7]. Thereafter, followup by annual imaging is important in determining patient's prognosis and could confirm or exclude the stability of such anomaly [10]. Knowing such variations is also essential in planning surgical and endovascular approaches, as these variations can require a different management strategy [3].…”

Section: Discussionmentioning

confidence: 99%

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Enlarged anterior communicating artery masquerading as intracranial aneurysm

Albanaa¹,

Al-Sharshahi²,

Hummadi³

et al. 2020

roneuro

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Background. The anterior communicating artery (ACoA) complex consists of the ACoA, the pre-and post-communicating segments of the anterior cerebral artery, and the recurrent artery of Heubner. It is the most common site for anatomical variations in the circle of Willis. Such variations can mimic intracranial aneurysms. Case description. A 30-year-old female presented with recurrent episodes of extreme headache and bilateral tinnitus. A brain computed tomography (CT) scan showed no significant lesions, while her CT-angiography (CTA) showed an enlarged vascular lesion at the ACoA, raising the suspicion for an ACoA aneurysm. A repeated CTA revealed a rare anatomical variation with a pattern of cross dominance in the ACoA complex; the left A1 and right A2 were dominant-enlarged, resulting in an enlargement of the ACoA. The presence of an ACoA aneurysm was hence excluded and the patient was managed conservatively. At 6-month follow-up, CTA showed no new findings. Conclusion. ACoA enlargement can result from unequal hemodynamics around the ACoA complex, which may be mistaken for an aneurysm. A thorough study of the imaging data is of pivotal importance and may change the management strategy.

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“…(B) Left anterior cerebral artery stroke causing urinary incontinence. Axial diffusion-weighted image (DWI) at left; coronal fluid-attenuated inversion recovery (FLAIR) image at right ( Lakhotia et al, 2016 ). (C) Carotid arteriogram showing a ruptured, bilobed aneurysm of the left pericallosal artery.…”

Section: Descending Inputs To Barrington’s Nucleusmentioning

confidence: 99%

The Brain and the Bladder: Forebrain Control of Urinary (In)Continence

Tish

Geerling

2020

Front. Physiol.

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Neural circuits extending from the cerebral cortex to the bladder maintain urinary continence and allow voiding when it is socially appropriate. Injuries to certain brain regions produce a specific disruption known as urge incontinence. This neurologic symptom is distinguished by bladder spasticity, with sudden urges to void and frequent inability to maintain continence. The precise localization of neural circuit disruptions responsible for urge incontinence remains poorly defined, partly because the brain regions, cell types, and circuit connections that normally maintain continence are unknown. Here, we review what is known about the micturition reflex circuit and about forebrain control of continence from experimental animal studies and human lesion data. Based on this information, we hypothesize that urge incontinence results from damage to a descending pathway that normally maintains urinary continence. This pathway begins with excitatory neurons in the prefrontal cortex and relays subcortically, through inhibitory neurons that may help suppress reflex micturition during sleep and until it is safe and socially appropriate to void. Identifying the specific cell types and circuit connections that constitute the continence-promoting pathway, from the forebrain to the brainstem, will help us better understand why some brain lesions and neurodegenerative diseases disrupt continence. This information is needed to pave the way toward better treatments for neurologic patients suffering from urge incontinence.

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A case of anterior cerebral artery A1 segment hypoplasia syndrome presenting with right lower limb monoplegia, abulia, and urinary incontinence

Cited by 10 publications

References 5 publications

Anomalies and Normal Variants of the Cerebral Arterial Supply: A Comprehensive Pictorial Review with a Proposed Workflow for Classification and Significance

Anomalies and Normal Variants of the Cerebral Arterial Supply: A Comprehensive Pictorial Review with a Proposed Workflow for Classification and Significance

Enlarged anterior communicating artery masquerading as intracranial aneurysm

The Brain and the Bladder: Forebrain Control of Urinary (In)Continence

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