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[A case of juvenile cerebral infarction caused by bilateral anterior cerebral artery dissection]

Akihiko Ueda1, Teruyuki Hirano, Ken-ichi Katsura

  • 1Department of Neurology, Kumamoto University School of Medicine.

Rinsho Shinkeigaku = Clinical Neurology
|March 29, 2003
PubMed

Insights

This case report details a rare instance of simultaneous bilateral anterior cerebral artery dissection leading to severe cerebral infarction. Despite treatment, the patient experienced significant neurological deficits, highlighting the critical nature of this condition.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroimaging

Background:

  • Cerebral infarction, particularly affecting the anterior cerebral artery (ACA) territories, can result from various vascular pathologies.
  • Arterial dissection is a recognized cause of stroke, but bilateral involvement of the ACA is exceptionally rare.

Observation:

  • A 38-year-old male presented with progressive neurological deficits including headache, dysarthria, and paraparesis.
  • Brain imaging revealed infarction in bilateral ACA territories, with subsequent deterioration despite antithrombotic therapy.
  • Cerebral angiography demonstrated occlusion and contrast pooling in the right ACA A2 segment, with stenosis and dilatation in the left ACA A2 segment, alongside an intimal flap.

Findings:

  • The patient was diagnosed with cerebral infarction secondary to bilateral anterior cerebral artery dissection.
  • The dissection involved the A2 segments of both ACAs, presenting with distinct angiographic findings in each artery.
  • Despite intensive antithrombotic therapy, the patient exhibited severe neurological impairment, including akinetic mutism and hemiparesis.

Implications:

  • This case underscores the possibility of simultaneous bilateral dissection of the anterior cerebral arteries as a cause of ischemic stroke.
  • Prompt diagnosis and understanding of the pathophysiology of ACA dissection are crucial for effective management and improved patient outcomes.
  • Further research into the underlying causes and optimal treatment strategies for bilateral arterial dissection is warranted.

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