Acute onset quadriplegia

Abstract

A 50-year-old man, with history of chronic alcohol intake was brought in a stuporous state to the emergency services having been found in that condition in his home the same day. Examination revealed the patient in an akinteic mute state with apparently normal cranial nerves, hypotonia and quadriplegia with bilateral extensor plantar reflex. CT scan and MRI of the brain revealed bilateral infarct parasagittally with normal Magnetic resonance venogram suggestive of bilateral anterior cerebral artery infarct. Follow-up magnetic resonance angiogram revealed an azygous anterior cerebral artery thus proving an infarct of unpaired anterior cerebral artery infarct as the cause for quadriplegia in this patient.

Figure 1

MRI T2 weighted images showing hyper intensities in bilateral ACA territory (white arrows).

Figure 2

Magnetic resonance angiogram anterior view showing azygous ACA (unpaired anterior cerebral artery) and hypoplasticleft ACA with absent A1 segment (white arrows).