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Ipsilateral leg weakness associated with carotid stenosis
M I Chimowitz1, E F Lafranchise, A J Furlan
1Department of Neurology, Cleveland Clinic Foundation, Ohio.
Stroke
|September 1, 1990
Summary
Ipsilateral leg weakness can occur with carotid artery disease. This rare presentation happens when the anterior cerebral artery is supplied by the ipsilateral carotid artery, impacting leg function.
Area of Science:
- Neurology
- Vascular Neurology
- Cerebrovascular Disease
Background:
- Carotid occlusive diseases typically cause contralateral neurological deficits.
- Ipsilateral motor or sensory symptoms are uncommon in carotid artery disease.
Observation:
- A 52-year-old man presented with aphasia, right hemiparesis, left leg weakness, and bilateral Babinski's signs.
- He experienced recurrent episodes of left leg numbness and incoordination preceding the major event.
- Cerebral angiography revealed significant bilateral carotid artery stenosis and an unusual anterior cerebral artery supply pattern.
Findings:
- Computed tomography confirmed infarcts in multiple brain regions, including the right frontoparietal, left frontal, and left parietal lobes.
- Cerebral angiography showed 60% stenosis of the right internal carotid artery and 80% stenosis of the left internal carotid artery.
- The right anterior cerebral artery was supplied exclusively by the left carotid circulation due to the absence of its A1 segment.
Implications:
- This case highlights a rare mechanism for ipsilateral leg weakness in carotid artery disease.
- It demonstrates the importance of considering atypical collateral circulation patterns in cerebrovascular events.
- Understanding these variations is crucial for accurate diagnosis and treatment of stroke patients.