Bilateral Caudate Nucleus Infarctions Following Upper Gastrointestinal Bleeding.

Area of Science:

• Neurology
• Vascular Neurology
• Neuroimaging

Background:

• Cerebral artery stenosis, particularly internal carotid artery (ICA) and anterior cerebral artery (ACA), can lead to ischemic stroke.
• Bilateral caudate nucleus infarction is uncommon and often associated with specific etiological factors.
• Hemodynamic compromise due to significant arterial stenosis is a recognized cause of ischemic events.

Observation:

• A 75-year-old woman presented with altered consciousness and hematemesis.
• Brain imaging demonstrated ischemia in bilateral caudate nuclei and the right cerebral watershed area.
• Stenosis of the right anterior cerebral artery (ACA) and bilateral internal carotid arteries (ICA) was identified, with hypoperfusion in the right caudate nucleus.

Findings:

• The patient's primary symptom was abulia, which showed gradual resolution.
• Follow-up imaging revealed improvement in the bilateral internal carotid artery (ICA) stenosis.
• The right anterior cerebral artery (ACA) stenosis persisted despite clinical improvement.

Implications:

• This case highlights a rare instance of bilateral caudate nucleus infarctions attributed to hemodynamic factors.
• The resolution of abulia correlated with the improvement of ICA stenosis, suggesting a hemodynamic etiology.
• Understanding hemodynamic changes in cerebrovascular stenosis is crucial for managing ischemic stroke, even in rare locations like the caudate nucleus.