Clinical symptoms of bilateral anterior cerebral artery territory infarction

Kobayashi, Shunsuke; Maki, Toshihide; Kunimoto, Masanari

doi:10.1016/j.jocn.2010.05.013

Cited by 13 publications

(9 citation statements)

References 23 publications

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“…[3][4][5][6][7] Its clinical features include paraparesis, hypobulia or abulia, aphasia (global or transcortical motor), frontal release reflexes, c a s e s t u d i e s urinary incontinence, and sensory deficits in the lower limbs. 8 Our patient had paraparesis, urinary incontinence, abulia, and transcortical motor aphasia.…”

Section: Questionsmentioning

confidence: 72%

Paraparesis as a Presenting Manifestation of Type 2 Diabetes

Rajput¹,

Sehgal²,

Aggarwal³

2013

Clinical Diabetes

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PRESENTATIONA 60-year-old patient with an insignificant medical history came to our outpatient department with complaints of sudden-onset leg weakness, urinary incontinence, and difficulty in speaking for the past 2 days. He reported no history of trauma, loss of consciousness, headache, vomiting, convulsions, or preceding fever.On examination, he was conscious, with a blood pressure of 170/96 mmHg and a regular pulse of 84 bpm. Spinal palpation revealed no abnormality or tenderness. He had abulia, trans-cortical motor aphasia, and urinary incontinence. Frontal release reflexes-the snout reflex, forced grasping reflex, and glabellar tap-were enhanced. Cranial nerves were normal bilaterally. Sensory loss was present in both lower limbs. Motor examination revealed spastic paraparesis. Bilateral Babinski, Chaddock, and Hoffmann signs were positive.Routine investigations revealed normal hemogram, liver, and renal function test results. However, his fasting and postprandial plasma glucose values were found to be 246 and 350 mg/dl, respectively. To know whether this hyperglycemia represented previously undiagnosed type 2 diabetes or stress hyperglycemia, we ordered an A1C, with a result of 9.6%. The patient was thus identified as having type 2 diabetes.Examination of ocular fundi showed bilateral nonproliferative diabetic retinopathy, urine examination documented proteinuria of 1 g/day, and a nerve conductions velocity study revealed bilateral sensory motor neuropathy. His lipid profile revealed triglycerides of 224 mg/dl, total cholesterol of 160 mg/dl, HDL cholesterol of 29 mg/dl, VLDL cholesterol of 32 mg/dl, and LDL cholesterol of 116 mg/dl.In view of clinical findings suggestive of frontal lobe involvement, we ordered a magnetic resonance imaging (MRI) study of the brain. The MRI showed bilateral, illdefined, wedge-shaped lesions in the anterior cerebral artery territories that were hyper-intense on T2W imaging (Figure 1). Diffusionweighted imaging confirmed these lesions to be acute infarcts (Figure 2). Magnetic resonance angiography (MRA) revealed narrowing of the A1 segment of the right anterior cerebral artery (ACA) and occlusion of the A2-A3 junction of the left ACA (Figure 3). Thus, the patient was diagnosed as having a bilateral ACA territory infarction.Two-dimensional transthoracic echocardiography revealed no

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Section: Questionsmentioning

confidence: 72%

Paraparesis as a Presenting Manifestation of Type 2 Diabetes

Rajput¹,

Sehgal²,

Aggarwal³

2013

Clinical Diabetes

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“…3,5 Hypobulia has previously been associated with lesions in the frontal pole but have also been reported with isolated basal ganglia lesions. 6 We believe that the patient's residual extrapyramidal signs and abulia can be attributed to bilateral infarcts in the vascular territory corresponding to the HRAs. The most consistent symptom reported in bilateral HRA infarctions is abulia, 5 but also akinetic mutism, attention disorder, and memory disturbances.…”

Section: Figure 2 Bihemispheric Supplymentioning

confidence: 85%

Bilateral anterior cerebral artery infarction presenting with acute paraparesis and parkinsonism

et al. 2019

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“…Bilateral frontal lobe damage can result in severe disruption of a patient's character [28,29]. Because treatment options for bilateral ACA steno-occlusive pathology are limited, bilateral ACA reconstruction using bonnet bypass should be taken into consideration.…”

Section: Discussionmentioning

confidence: 99%