Bilateral anterior cerebral artery infarction resulting from explosion-type injury to the head and neck.

Abstract

A 43-year-old woman suffered a blast-type injury to the head and neck. She subsequently developed bilateral internal carotid artery occlusion and bilateral anterior cerebral artery infarction not demonstrated by magnetic resonance imaging scan 24 hours after the explosion, but confirmed by a second scan 8 days after the explosion. In patients with blast-type injury to the head and neck who develop coma with a nonfocal neurological exam, the possibility of bilateral carotid artery occlusion and bilateral ischemic infarction should be considered.C arotid artery occlusion is a well-recognized, although infrequent, complication of nonpenetrating trauma to the head and neck.We report a patient who suffered a blast-type injury to the head and neck and subsequently developed bilateral internal carotid artery occlusion and bilateral anterior cerebral artery infarction. Case ReportA 38-year-old woman with a history of mild hypertension and Graves' disease was preparing Christmas dinner for her family when, in attempting to light her gas stove, the stove exploded, producing minor burns to her neck, face, and scalp. There was no loss of consciousness. She was noted initially to be fully alert and neurologically intact, with first-and seconddegree burns on the face, ears, scalp, posterior neck, and upper back estimated to cover approximately 4% of the total body surface area. Eleven hours after the explosion, she became acutely unresponsive and developed episodic decerebrate posturing with episodic hypertension. She had slow roving conjugate eye movements, normal pupillary reaction, normal funduscopic examination, and symmetric lower cranial nerve function. Bilateral limb hypertonia, hyperactive reflexes, and extensor toe signs were present.Emergency computed tomogram of the head with and without contrast was normal. An electroencephalogram showed mild diffuse slowing. Intracranial pressure, cerebrospinal fluid profile, screens

Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings

“…We observed only two patients (4%) with bilateral ACA territory infarction, in fact, it occurs uncommonly, 13 patients with bilateral ACA infarction have been reported in the literature (Freemon, 1971; Swanson et al ., 1987; Bogousslavsky & Regli, 1990; Lipschutz et al ., 1991; Ferbert & Thorn, 1992; Borggreve et al ., 1994; Minagar & David, 1999). Bilateral ACA territory infarct causes severe neurological syndromes including akinetic mutism, severe sphincter dysfunction, and dependent functional outcome.…”

Bilateral anterior cerebral infarcts from a depressed anterior base of skull fracture: Case report and review of the literature

“…5,11 Direct intracranial vascular trauma is a rare manifestation of injury although involvement of the Circle of Willis should be considered in association with fractures through the clivus or when internal carotid artery dissection is suspected. 14,20,22,25,29 Fractures through the sella turcica may also involve its resident pituitary gland as well as potential optic nerve damage at the level of the optic chiasm. Usually greater forces are involved for this type of damage to occur and therefore more extensive intracranial vascular involvement should be considered.…”

Simultaneous Cardiogenic Embolism in Bilateral Internal Carotid Arteries – Carotid Ultrasonography, MRI and Autopsy Findings

“…Since then, only a few patients have been reported with acute bilateral ICA territory infarction associated with atherosclerosis [1,2,4,6,7], head trauma [8][9][10][11], catheter trauma [12] and cardiogenic embolism [1][2][3][4]. Usually, patients with atherosclerosis have had long-standing occlusion of one carotid artery, and manifested bilateral signs and coma only when the other side became occluded.…”