Anterior choroidal artery infarction

Abstract

DesCripTionA 38-year-old male patient with a history of hypertension presented with left hemiplegia, hemianaesthesia and hemianopia. MRI of the brain showed anterior choroidal artery (AchA) territory infarct (figure 1). MRI brain angiography and 2D echo were normal. Serum fasting lipid profile, sugar levels, thyroid studies, serum homocysteine levels and antinuclear antibody (ANA), double-stranded deoxyribonucleic acid (DsDNA) and antiphospholipid antibody (APLA) were negative. Trans-oesophageal echocardiography and Holter monitoring were normal. Workup for sickle cell anaemia was negative.The territory of AchA is shown in figure 2.

Unusual Anterior Choroidal Artery Occlusion in Pediatric Type 1 Diabetes: A Case Report Highlighting Atypical Presentation

“…The pathologies involving the AChA range from infarction, aneurysm, Moyamoya disease, brain arteriovenous malformations (AVM), or arteriovenous fistula (AVF), to tumors. Isolated AChA infarcts are rare, with a prevalence ranging from 2-11% [ 5 ].…”

“…The most common manifestations include hemiparesis or hemiplegia, sensory symptoms affecting the contralateral side, dysarthria, lower facial nerve palsy, visual field disturbances, or even neglect syndrome. The classical triad of contralateral hemiplegia, contralateral hemisensory loss, and contralateral homonymous hemianopia is seen less commonly and is usually seen in complete territorial infarct [ 4 , 5 ]. ICA stenosis or cardio-embolism are the most common causes of complete AChA ischemic strokes.…”

“…ICA stenosis or cardio-embolism are the most common causes of complete AChA ischemic strokes. On the other hand, diabetes mellitus, hypertension, and hyperlipidemia usually cause smaller strokes that only affect a part of the AChA territory [ 5 , 6 ]. However, in our case, there was an infarct in the entire AChA territory without any cardioembolic risk factor and in the absence of ICA stenosis.…”

Pure Thalamic Infarct: 8-Year Follow-Up Study in a Hospital in China

“…Furthermore, other etiologies should be considered if patients with acute infarct do not have the above mentioned risk factors and present with the following characteristics: hereditary stroke background, migraine, recurrent stroke, susceptibility-weighted imaging-proved multiple microbleeds, or temporal lobe white matter hyperintensity. Accordingly, the etiologies of cerebral amyloid angiopathy; hereditary small vessel disease (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy); cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy; Fabry disease; mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes; venous collagenosis; immuneinflammation-mediated vasculitis; and radiation exposure should be considered (7,14). The anterior choroidal artery (AChA) infarct is most easily misrecognized as a thalamic blood supply infarct.…”

“…The anterior choroidal artery (AChA) infarct is most easily misrecognized as a thalamic blood supply infarct. AChA, originating from the terminal internal cerebral artery, affects the posterior limb of the internal capsule, lateral geniculate, thalamus, uncus, or cerebral peduncle ( 15 ). In collaboration with the PCoA, the AChA, and PCoA territories closely overlap ( 16 ).…”