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Updated: Dec 3, 2025
Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Minor stroke with bilateral acute infarctions and combined vascular anomalies: A complex case report
Fabrizio Giammello1, Cristina Dell'Aera1, Francesco Grillo1
1Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Abstract:
We report the case of a patient with bilateral acute ischemic lesions (AIS) in middle cerebral artery (MCA) territory associated with an extremely rare combination of anomalies of the aortic arch and the left internal carotid artery (ICA). The diagnosis deposed for bilateral minor embolic stroke of undetermined source (ESUS), inpatient with patent foramen ovale (PFO) and positive antiphospholipid (aPL) test. To our knowledge, this is the first description of a patient with this rare combination of vascular anomalies.
Insights
This case study details a rare instance of bilateral acute ischemic lesions in the middle cerebral artery territory. The patient presented with embolic stroke of undetermined source, linked to unique aortic arch and left internal carotid artery anomalies.
Area of Science:
- Neurology
- Vascular Medicine
- Cardiology
Background:
- Acute ischemic lesions (AIS) in the middle cerebral artery (MCA) territory can result from various embolic events.
- Embolic stroke of undetermined source (ESUS) presents a diagnostic challenge, often requiring investigation into multiple potential causes.
- Anomalies of the aortic arch and carotid arteries are uncommon but can predispose individuals to cerebrovascular events.
Observation:
- A patient presented with bilateral AIS within the MCA territory.
- The patient exhibited a rare combination of aortic arch anomalies and left internal carotid artery (ICA) anomalies.
- Diagnostic workup revealed patent foramen ovale (PFO) and a positive antiphospholipid (aPL) test.
Findings:
- The patient was diagnosed with bilateral minor embolic stroke of undetermined source (ESUS).
- The stroke was associated with a unique confluence of vascular anomalies: aortic arch and left ICA abnormalities.
- The presence of PFO and a positive aPL test were noted comorbidities.
Implications:
- This case highlights the importance of comprehensive vascular imaging in patients with cryptogenic stroke.
- The rare combination of anomalies described may represent a novel risk factor for ESUS.
- Further research is warranted to understand the specific mechanisms linking these vascular anomalies to embolic stroke.
