scholarly journals Unique Presentation of Akinetic Mutism and Coexisting Thyroid Storm Relating to Stroke

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Mohankumar Kurukumbi ◽  
Thao Dang ◽  
Najeeb Crossley ◽  
Alice Esame ◽  
Annapurni Jayam-Trouth
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Case Reports ◽  
Anterior Cingulate ◽  
Akinetic Mutism ◽  
Thyroid Storm ◽  
African American Female ◽  
Subcortical Structures ◽  
Clinical Presentations

Akinetic mutism is described in various clinical presentations but typically is defined as a state wherein the patient appears awake but does not move or speak. It can be divided into two different subtypes; the most common subtypes depend on the lesion location, mesencephalic-diencephalic region, also called apathetic akinetic mutism (somnolent mutism), and those involving the anterior cingulate gyrus and adjacent frontal lobes called hyperpathic akinetic mutism. The pathway of akinetic mutism is believed to originate from circuits that link the frontal and subcortical structures. This case reports a 48-year-old African American female with bilateral anterior cerebral artery stroke and akinetic mutism with coexisting thyroid storm. This patient with bilateral anterior cerebral artery infarcts presented with characteristics that are typical for akinetic mutism such as having intact eye movements but an inability to respond to auditory or visual commands. With the incidence of bilateral anterior cerebral artery (ACA) ischemic stroke being rare and the incidence of akinetic mutism secondary to ischemic stroke even rarer, we suspect that this patient potentially had a unilateral occlusion of anomalous anterior cerebral vasculature.

scholarly journals Reversible Akinetic Mutism after Aneurysmal Subarachnoid Haemorrhage in the Territory of the Anterior Cerebral Artery without Permanent Ischaemic Damage to Anterior Cingulate Gyri

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
François-Xavier Sibille ◽  
Philippe Hantson ◽  
Thierry Duprez ◽  
Vincent van Pesch ◽  
Simone Giglioli
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Cerebral Artery ◽  
Structural Damage ◽  
Anterior Cerebral Artery ◽  
Mass Effect ◽  
Favourable Outcome ◽  
Anterior Cingulate ◽  
Akinetic Mutism ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Cingulate Gyri

We report on two cases of transient akinetic mutism after massive subarachnoid haemorrhage due to the rupture of an intracranial aneurysm of the anterior cerebral artery (ACA). In the two cases, vasospasm could not be demonstrated by imaging studies throughout the clinical course. Both patients shared common radiological features: a hydrocephalus due to haemorrhagic contamination of the ventricular system and a mass effect of a subpial hematoma on the borders of the corpus callosum. Patients were also investigated using auditory event-related evoked potentials at acute stage. In contrast to previous observations of akinetic mutism, P300 wave could not be recorded. Both patients had good recovery and we hypothesized that this unexpectedly favourable outcome was due to the absence of permanent structural damage to the ACA territory, with only transient dysfunction due to a reversible mass effect on cingulate gyri.

scholarly journals Dissecting Aneurysms at the A1 Segment of the Anterior Cerebral Artery. Two Case Reports.

2001 ◽  
Vol 41 (5) ◽  
pp. 271-278 ◽  
Author(s):  
Jun HIRAO ◽  
Hisayo OKAMOTO ◽  
Takashi WATANABE ◽  
Shuichiro ASANO ◽  
Akira TERAOKA
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Case Reports ◽  
Dissecting Aneurysms

scholarly journals Fenestrated Anterior Cerebral Artery with Associated Arterial Anomalies

2008 ◽  
Vol 14 (4) ◽  
pp. 441-445 ◽  
Author(s):  
S.J. Dimmick ◽  
K.C. Faulder
Keyword(s):  
Cerebral Aneurysm ◽  
Clinical Significance ◽  
Cerebral Artery ◽  
Cerebral Circulation ◽  
Anterior Cerebral Artery ◽  
Case Reports ◽  
Vascular Anomalies ◽  
Review Of The Literature ◽  
Aneurysm Formation ◽  
Arterial Anomalies

Fenestration of the A2 segment is extremely rare. Cerebrovascular fenestration may be associated with an increased incidence of cerebral aneurysm and other vascular anomalies. Two case reports are presented which identify a fenestration of the A2 segment and other normal variations of the intra-cerebral circulation. A review of the literature has been undertaken to determine the prevalence and embryology of anterior cerebral artery fenestrations, their clinical significance and the association with aneurysm formation and other intracranial vascular anomalies.

scholarly journals Saccular Aneurysm of the Azygos Anterior Cerebral Artery: Three Case Reports

2007 ◽  
Vol 42 (4) ◽  
pp. 342 ◽  
Author(s):  
Jun Suk Huh ◽  
Sang Keun Park ◽  
Jun Jae Shin ◽  
Tae Hong Kim
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Case Reports ◽  
Saccular Aneurysm

scholarly journals A Rare Case of Unilateral Foix-Chavany-Marie Syndrome

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Courtney Raab ◽  
Farrukh Chaudhry, MD
Keyword(s):  
Ischemic Stroke ◽  
Case Report ◽  
Rare Case ◽  
Speech Therapy ◽  
Case Reports ◽  
Intravenous Thrombolysis ◽  
White Matter Lesions ◽  
African American Female ◽  
Presenting Symptoms ◽  
Opercular Syndrome

Background: Bilateral anterior opercular syndrome, or Foix-Chavany-Marie Syndrome (FCMS), is a neurological condition characterized by bilateral anterior opercular lesions. Common presenting symptoms of this rare suprabublar palsy include dysarthria, or slurred speech, as well as paralysis of facial, pharyngeal, lingual, and masticatory voluntary muscles while autonomic function is preserved.1 Most cases of FCMS are bilateral, yet some rare cases have been reported with unilateral opercular lesions with preexisting contralateral white matter lesions.2 In this case report we present a rare case of unilateral FCMS in a patient who had an acute anterior left opercular infarct, as well as a residual right parietal subcortical stroke. Project Methods: The patient we present is a 49 year old African American female with a history of hypertension and previous stroke with residual spastic right hemiplegia who presented to the ED for evaluation of right sided facial droop, right sided weakness, and slurred speech. Patient was evaluated by acute stroke team and was treated with intravenous thrombolysis (Alteplase). On hospital day 2, the patient developed complete disarticulation, unable to produce any speech but able to communicate by appropriate gestures and writing. The patient’s symptoms included anarthria, weakness of bilateral masseters, and lateral/medial pterygoids without dysphagia. Results: The MRI brain showed left insular region/frontal opercular ischemic stroke and a small right parietal subcortical ischemic stroke, likely embolic in nature. Over the hospital stay, the patient’s motor function improved but her anarthria persisted. These radiologic findings along with the symptomology proved consistent with FCMS. She was discharged to home with an NIH stroke scale of 5 and recommended outpatient speech therapy. Conclusion: In this case report, we describe a patient that presents with an extremely rare case of unilateral FCMS, with a preexisting contralateral parietal infarct that could have collectively caused anarthria and masseter weakness.   Works Cited 1. Milanlioglu A, Aydın MN, Gökgül A, Hamamcı M, Erkuzu MA, Tombul T. Ischemic Bilateral Opercular Syndrome. Case Reports in Medicine. 2013;2013:1-3. doi:10.1155/2013/513572. 2. Sa F, Cordeiro IM, Mestre S, Nzwalo H. Unilateral opercular infarction presenting with FoixChavany-Marie syndrome. Case Reports. 2014;2014. doi:10.1136/bcr-2014-206439.

scholarly journals Bilateral cerebral infarction associated with severe arteriosclerosis in the A1 segment: a case report

2019 ◽  
Vol 47 (3) ◽  
pp. 1373-1377
Author(s):  
Jing Lin ◽  
Wenbiao Xian ◽  
Rong Lai ◽  
Jiaoxing Li ◽  
Yufang Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Large Artery ◽  
Anterior Circulation ◽  
The Right ◽  
Left Middle

Large artery atherosclerosis and cardioembolism are the two major subtypes of ischemic stroke. We herein describe a 75-year-old man with acute complete cerebral infarction in the typical territories of the bilateral anterior cerebral artery (ACA) and left middle cerebral artery. Brain magnetic resonance angiography showed that the right A1 segment of the ACA was affected by severe arteriosclerosis and that the right ACA other than the A1 segment was compensated by the left ACA through the anterior communicating artery. Acute cardioembolism only occluded the left anterior circulation but simultaneously blocked the right ACA due to decompensation. We presume that the bilateral cerebral infarctions were caused by chronic atherosclerosis and acute cardioembolism.

Left Unilateral Ideomotor Apraxia in Ischemic Stroke within the Territory of the Anterior Cerebral Artery

1992 ◽  
Vol 2 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Seiji Kazui ◽  
Tohru Sawada ◽  
Hiroaki Naritomi ◽  
Yoshihiro Kuriyama ◽  
Takenori Yamaguchi
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Ideomotor Apraxia

scholarly journals Clinical and neuroimaging analysis of carotid infarction in the acute ischemic stroke

2021 ◽  
Vol 17 (5) ◽  
pp. 36-46
Author(s):  
M.M. Prokopiv
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Cerebral Arteries ◽  
Clinical Manifestations ◽  
Short Term ◽  
Middle Cerebral Arteries ◽  
Proximal Anterior Cerebral Artery ◽  
The Brain

Background. The assessment of clinical manifestations in patients with acute pre-circular infarction is important for verification of the lesion, the choice of the treatment program, prediction of the stroke consequences. The purpose is to investigate the clinical, neurological, and neuroimaging features of lacunar and non-lacunar carotid infarctions in acute ischemic stroke and to assess their short-term consequences. Materials and methods. There was performed a clinical and radiological analysis of carotid infarction in 540 patients with acute ischemic stroke, which were divided into two groups: 155 patients were verified for infarcts in the cortex and white matter of the brain in the vasculature of the anterior and middle cerebral artery; in 385 patients, infarct foci were found in the area of the deep hemispheres of the brain (subcortical-capsular infarcts). Results. Clinical neuroimaging analysis of patients with ischemic stroke in the vasculature of the cortical branches of the anterior and middle cerebral arteries of the anterior circulatory basin showed that acute cerebral circulatory disorders caused the development of small cortical infarctions in 89 (57.4 %) patients and 65 (41 %) — lacunar infarction, in one patient (0.7 %) with occlusion of the proximal anterior cerebral artery — total infarction. The neurological clinical picture of infarcts of varying localization, which was determined by the location and size of the lesion, was described. Conclusions. The obtained results showed that the consequences of anterior circular infarctions depended on the localization of the lesion of the arterial area, the caliber of the infarction of the dependent artery, the size of the infarct locus. For the most part, these factors determined the background severity of neurological deficit after the development of acute ischemic stroke.

scholarly journals Anterior Cerebral Artery Stroke: Role of Collateral Systems on Infarct Topography

Stroke ◽  
2021 ◽  
Author(s):  
Tharani Thirugnanachandran ◽  
Richard Beare ◽  
Melissa Mitchell ◽  
Chloe Wong ◽  
Jason Vuong ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Computer Model ◽  
Anterior Cerebral Artery ◽  
Artery Occlusion ◽  
Anterior Cingulate ◽  
Anterior Communicating Artery ◽  
Cingulate Gyrus ◽  
Vessel Occlusion ◽  
Cerebral Artery Occlusion

Background and Purpose: The circle of Willis (CoW) and leptomeningeal anastomoses play an important role in transforming infarct topography following middle cerebral artery occlusion. Their role in infarct topography following anterior cerebral artery occlusion is not well understood. The aim of this study was to evaluate the role of the CoW and leptomeningeal anastomoses in modifying regional variation in infarct topography following occlusion of the anterior cerebral artery and its branches. Methods: Perfusion and magnetic resonance imaging of patients with anterior cerebral artery stroke and evidence of vessel occlusion were segmented and manually registered to standard brain template for voxel-wise comparison. Next, a computer model of the cerebral arteries was formulated as network of nodes connected by cylindrical pipes. The experiments included occlusion of successive branches of the anterior cerebral artery while the configurations of the CoW were varied. Results: Forty-seven patients with a median age of 77.5 years (interquartile range, 68.0–84.5 years) were studied. The regions with the highest probabilities of infarction were the superior frontal gyrus (probability =0.26) and anterior cingulate gyrus (probability =0.24). The regions around the posterior cingulate gyrus (probability =0.08), paracentral lobule (probability =0.05), precuneus and superior parietal lobule (probability =0.03) had a low probability of infarction. Following occlusions distal to the anterior communicating artery, the computer model demonstrated an increase in flow (>30%) in neighboring cortical arteries with leptomeningeal anastomoses. Conclusions: Traditionally the CoW has been regarded as the primary collateral system. However, our computer model shows that the CoW is only helpful in redirecting flow following proximal vessel occlusions (pre-anterior communicating artery). More important are leptomeningeal anastomoses, which play an essential role in distal vessel occlusions, influencing motor outcome by modifying the posterolateral extent of infarct topography.

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