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Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
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Published on: July 21, 2013

Bilateral caudate nucleus infarction associated with a missing A1 segment.

Takuya Fukuoka1, Aiko Osawa, Yasuko Ohe

  • 1Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan. tfukuoka@saitama-med.ac.jp

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|December 20, 2011
PubMed
Summary

A rare case of bilateral caudate nucleus infarction, a type of stroke, occurred in an 81-year-old man with atrial fibrillation and a variant circle of Willis. Symptoms of abulia resolved within a year.

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Area of Science:

  • Neurology
  • Cardiology
  • Radiology

Background:

  • Cardioembolic stroke is a significant cause of ischemic brain injury.
  • The circle of Willis is a critical arterial structure at the base of the brain, and variations can impact cerebral blood flow.
  • Bilateral caudate nucleus infarction is an uncommon presentation of stroke.

Observation:

  • An 81-year-old male with atrial fibrillation presented with sudden disturbance of consciousness.
  • Neurological examination revealed abulia, characterized by lack of spontaneous speech and activity.
  • Brain magnetic resonance imaging (MRI) demonstrated infarction in the bilateral caudate nucleus heads and left frontal lobe.

Findings:

  • 3D computed tomography angiography revealed an absent left A1 segment, indicating a variant circle of Willis.
  • The infarction pattern suggests a cardioembolic source in the context of this anatomical variant.
  • Complete resolution of abulia was observed one year post-stroke.

Implications:

  • This case highlights the potential for rare stroke patterns in patients with anatomical variations like a variant circle of Willis.
  • Understanding these associations is crucial for accurate diagnosis and risk assessment in cerebrovascular disease.
  • The findings underscore the importance of advanced neuroimaging in elucidating complex stroke etiologies.