Bilateral Stroke -Unpaired Anterior Cerebral Artery Infarct Rare Presentation

Abstract

ACA territory is an uncommon site for occlusive vascular strokes. Small degree of asymmetry of anterior arteries is present in 80% of patients. Common variants of anterior cerebral arteries include aplasia or hypoplasia of A1 segment. Hypoplasia is found in 10% and aplasia in 1-2% of postmortem examinations. Of all ischemic strokes ACA territory strokes constitutes only 0.6 to 3%. Bilateral ischemic stroke in unpaired ACA is rare entity. We report a case of unpaired ACA due to hypoplasia of right ACA, presenting as stuttering hemiplegia with bilateral focal neurological deficit.

Enlarged anterior communicating artery masquerading as intracranial aneurysm

“…Vascular anomalies of the ACoA complex are not uncommon and are mostly encountered in the A1 segment [6]. A unilateral hypoplastic A1 segment is one of the most common anomalies in the circle of Willis with an incidence of 3% [3,7]. Marinković et al described two types of A1 hypoplasia based on carotid angiogram namely, mild and extreme hypoplasia [8].…”

“…These variations manifested radiologically as an enlarged ACoA with a pouched-out appearance leading to a suspicion of an ACoA aneurysm. 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].…”