Introdução. A irrigação do sistema nervoso central (SNC) advém do Polígono de Willis (PW), existindo diversas variações na sua distribuição denominadas variações anatômicas. Objetivo. Relato de caso de paraplegia de origem central por variação anatômica no PW. Relato. Mulher, 78 anos, com queda da própria altura seguida de fraqueza em membros inferiores (MMII) e membro superior direito (MSD). Apresentava-se com apagamento do sulco nasolabial direito, paraplegia flácida crural assimétrica, pior a esquerda, monoplegia flácida de MSD, hipoestesia em MMII e sinal de Babinski bilateral. Tomografias (TC) de coluna cervical e dorsal afastaram causas traumáticas. TC de crânio evidenciou hipodensidade fronto-parietal esquerda, sugerindo isquemia recente. Em investigação, ecocardiograma e ultrassom doppler das artérias carótidas e vertebrais dentro da normalidade. Ressonância de crânio com sinais de infarto recente nos giros do cíngulo e frontal superior esquerdos e mínimos focos isquêmicos córtico-subcorticais no giro frontal superior direito, com agenesia de porção A1 da artéria cerebral anterior direita na angiorressonância. Resultados. A doença mais prevalente no SNC é o AVCi, cujos sintomas dependem da região cerebral afetada. A apresentação atípica relatada foi decorrente de variação anatômica no PW, a agenesia de porção A1 da artéria cerebral anterior direita. A prevalência de variações anatômicas no PW é cerca de 68,22%, sendo a artéria comunicante posterior o segmento mais afetado. Conclusão. a maioria das variações anatômicas da circulação arterial cerebral não geram repercussão clínica, pois, em geral, não são patológicas. Todavia, é importante conhecê-las para fazermos os diagnósticos diferenciais nos quadros atípicos e minimizarmos iatrogenias cirúrgicas.
Introduction: The ischemic stroke is one of the main causes of death and disability in Brazil. Among the main risk factors are age, atrial fibrillation (AF), diabetes, dyslipidemia and physical inactivity. The main etiology of stroke is cardioembolic, resulting in obstruction of the cerebral arteries by a thrombus of cardiac origin. The artery most affected in ischemic strokes is the middle cerebral artery. The stroke has main characteristics, with emphasis on the sudden onset of symptoms, involvement of a focal area, ischemia caused by obstruction of a vessel and neurological deficits depending on the affected area. Graphesthesia is defined as a cutaneous sensory ability to recognize letters or numbers traced on the skin. The loss of this sensory ability is known as agraphesthesia. Case Report: M.A.F.O. female, 78a, arrived at the UPA complaining of mental confusion. Patient denies previous stroke. Personal history of systemic arterial hypertension. Upon physical examination, the patient was conscious, self and disoriented and inattentive. He was able to repeat and evoke words, without measurable motor déficits. Left upper limb with agraphestesia. Computed tomography was requested, which showed an extensive hypodense area in the right parietoccipital region, which leads to the erasure of the furrows between the adjacent gyres, which may correspond to a recent ischemic event. Magnetic resonance imaging, diffusion-restricted area with correspondence on the ADC map, located in the right temporoparietal region inferring an acute ischemic event. An electrocardiogram was also requested, which showed an irregular rhythm, characteristic of atrial fibrillation, resulting in a diagnostic hypothesis of cardioembolic ischemic stroke. Discussion: The involvement of post-central ischemic gyrus lesions may correspond to paresthesia, anesthesia, hypoesthesia; the involvement of secondary and terciary areas of sensitivity in the upper parietal lobe, especially in the active movements of the hand and in the modalities of integrated sensitivity, their lesions may be clinically affected by: apraxias, dysgraphias, hemineglect, agraphestesia, stereoagnosia and spacial disorientation.
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