Bihemisphere Ischemia Due to a Unilateral Lesion: A Case Report |
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| Institution: | 2. Department of Neurology, Harbor-UCLA Medical Center, Torrance, California;3. Department of Radiology, VA Long Beach Healthcare System, Long Beach, California;2. Comprehensive Stroke Center, Department of Neurology, Masaryk Hospital Ústí nad Labem, KZ a.s., Ústí nad Labem, Czech Republic;3. Department of Radiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic;4. Department of Radiology, Masaryk Hospital Ústí nad Labem KZ a.s. and Faculty of Health Studies, J.E. Purkinje University, Ústí nad Labem, Czech Republic;5. Department of Medical Biophysics and Statistics, Palacký University Medical School, Olomouc, Czech Republic;6. Department of Emergency, Masaryk Hospital Ústí nad Labem KZ a.s., Ústí nad Labem, Czech Republic;2. The Warren Alpert Medical School of Brown University, Department of Neurosurgery, Providence, Rhode Island;3. The Warren Alpert Medical School of Brown University, Department of Radiology, Providence, Rhode Island;5. Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York;4. The Warren Alpert Medical School of Brown University, Department of Internal Medicine, Division of Cardiovascular Medicine, Providence, Rhode Island;2. Department of Public Health, Emory University, Atlanta, Georgia;3. Department of Neurology, University of Utah, Salt Lake City, Utah;4. Department of Neurology, University of Chicago, Chicago, Illinois;6. Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida;5. Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama;11. Department of Neurology, University of California at Los Angeles, Los Angeles, California;2. National Institute for Health and Welfare, Helsinki, Finland |
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| Abstract: | Bihemispheric ischemic strokes secondary to unilateral vessel disease are uncommon. We present the case of a 70-year-old man with multiple acute/subacute bilateral infarcts. The patient was found to have stenosis of the left internal carotid artery secondary to herpes zoster ophthalmicus vasculopathy, with involvement of the left proximal middle and anterior cerebral arteries. Angiographic studies also revealed A1 segment aplasia of the right anterior cerebral artery (ACA), thus indicating dependence on the left-sided circulation for perfusion of the bilateral ACA vascular territory. This case illustrates how A1 segment aplasia, an anatomic variant of the circle of Willis detected by angiographic studies, can contribute to bilateral infarction in the ACA vascular territory. |
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