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. 2008 Jun 2:2:188.
doi: 10.1186/1752-1947-2-188.

Acute bilateral anterior circulation stroke due to anomalous cerebral vasculature: a case report

Brian F Menezes  1 , Beverley Cheserem, Jothy Kandasamy, Donnacha O'Brien
Affiliations

Acute bilateral anterior circulation stroke due to anomalous cerebral vasculature: a case report

Brian F Menezes et al. J Med Case Rep. .

Abstract

Introduction: Simultaneous bilateral cerebrovascular infarction is relatively rare and its initial presentation as a space-occupying lesion is extremely uncommon. However, bilateral infarction can result from unilateral occlusion of anomalous cerebral vasculature.

Case presentation: We report the case of a man presenting with lower limb weakness and aphasia of acute onset with initial computerised tomography suggesting bifrontal neoplasm. However, further investigation confirmed bilateral anterior cerebral artery territory infarction with a hypoplastic left anterior cerebral artery with the right anterior cerebral artery supplying both frontal lobes (an anatomical variant). We present the clinical and diagnostic features of this presentation and attempt to ascertain, by reviewing existent medical literature, the frequency and patterns of structural variations in cerebral vasculature.

Conclusion: Simultaneous bilateral cerebral infarction can be the result of a unilateral cerebral artery occlusion and this can potentially mimic a space-occupying lesion. Anomalies of cerebral vasculature are not as rare as is usually believed and this should be borne in mind when investigating unusual presentations of cerebrovascular infarction.

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Figures

Figure 1
Figure 1
Computerised tomography of the head demonstrating a bifrontal area of hypodensity reported as a parasagittal space-occupying lesion.
Figure 2
Figure 2
T1/T2 weighted magnetic resonance images initially erroneously reported as demonstrating a bifrontal neoplastic space-occupying lesion.
Figure 3
Figure 3
Right and left internal carotid artery angiograms. (A) Right internal carotid artery angiogram demonstrating the internal carotid artery dividing into middle and anterior cerebral arteries with the latter additionally supplying the left anterior cerebral artery territory. (B) Left internal carotid artery angiogram revealing the internal carotid artery branching into the middle carotid artery with absent contrast flow into the anterior cerebral artery territory. This may occur in vessel occlusion, but in this case it indicates an aplastic A1 segment.
See this image and copyright information in PMC

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