Noninvasive assessment of posterior cerebral artery stenosis inducing hemiplegia

Posterior cerebral artery infarction usually causes hemianopsia and, occasionally, symptoms referred to infarction in the territory of the middle cerebral artery. We describe a case of cerebral infarction of the posterior cerebral artery territory that mimicked middle cerebral artery occlusion. A patient with infarction of the right surface and deep territories of the posterior cerebral artery presented with left hemiplegia and left homonymous hemianopsia. Brain computed tomography and magnetic resonance investigation disclosed a hypodense lesion in the occipital right lobe and the medial and inferior part of the right temporal lobe. Transcranial Doppler studies disclosed an abnormally increased blood flow velocity in the proximal posterior cerebral artery and a sharp reduction in distal flow velocity. This case underscores the utility of noninvasive techniques to diagnose posterior artery stenosis: they were not only more economical than angiography but also spared the patient discomfort and risk.