Anterior choroidal artery variant and acute embolic stroke. Case report

Abstract

The anterior choroidal artery has the cortical branches to the temporal, parietal, and occipital lobes in the early embryological stage, which later become the posterior cerebral artery distal to the posterior communicating artery (P2-4). Acute embolic stroke occurred in a 57-year-old man with an anterior choroidal artery having such a persistent embryonic branch to the temporal lobe. Recognition of this embryological form of the anterior choroidal artery is clinically important in acute cerebral ischaemia because the cerebral region between the territories supplied by the middle cerebral artery and the anterior choroidal artery is shown on carotid angiography as an avascular area, which could be misunderstood as a region of the acute ischaemia.

Figure 1

Right carotid angiograms: (A frontal and B lateral views) show a small saccular aneurysm (arrow) at the origin of the anterior choroidal artery, which has embryological branches to the temporal lobe (closed arrowheads). The ring indicates an avascular area caused by embolic occlusion of the prefrontal artery. The cortical region between the territories of the distal middle cerebral artery and the anterior choroidal artery (open circle) mimics the avascular area suggestive of acute cerebral ischaemia. The open arrowhead indicates the posterior communicating artery. Left vertebral angiogram (C frontal view) shows the right posterior cerebral artery without temporal branches.