TITLE:
Anterior Choroidal Artery Territory Stroke in Young Patient
AUTHORS:
Denise Lopes, Helena Felgueiras, Pedro Carneiro
KEYWORDS:
Anterior Choroidal Artery, Stroke, Dissection, Young Patient
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.8,
August
20,
2014
ABSTRACT: Introduction: Stroke incidence in young patients
is about 10 cases in 100.000, according to several European studies. In this
age group arterial dissection is one of the main pathological mechanisms
involved. The internal carotid’s artery (ICA) main supraclinoid branch is the
anterior choroidal artery (AChA). The occurrence of infarction in its territory
due to internal carotid dissection is considered to be a rare event and may
have different clinical presentations due to anatomical variability. Clinical
case: A 31-year-old male patient, without any known cardiovascular risk factors
or chronic medication, presented with acute onset of stabbing right sided
headache while practicing football. Visual disturbances and hemiparesis with
hypesthesia of his left arm were also mentioned. On admission left homonymous
hemianopsia, left hemiparesis and left extensor plantar reflex were present.
Brain magnetic resonance showed hyperintensity of T2 and FLAIR signals and restricted
diffusion pattern suggested acute/subacute infarctions in the thalamic and
subcapsular area, corpus callosum, splenium and subcortical parietal right
region. Magnetic resonance angiography (MRA) of the brain showed reduction of
the right ICA’s caliber, mainly of its supraclinoid segment in which a marked
irregular stenosis was visualized, suggestive of arterial dissection. This
stenotic segment included the origin of the AChA and of the posterior
communicating cerebral artery with an exchange in their territories. Lumbar
puncture results were normal as were analytical investigations which included
CBC, sedimentation rate, syphilis serology and immunologic and prothrombotic
screen. There were no phenotype characteristics suggestive of connective tissue
disease. Conclusion: Trauma seems to be the most probable lesion mechanism for
the occurrence of intracranial carotid’s dissection in this particular case, as
the patient was practicing vigorous sports at time of onset. In view of great
anatomic variability and multiple anatomical sites supplied by the AChA its
occlusion will induce a wide range of clinical manifestations.