Open AccessSimultaneous anterior and posterior circulation stroke secondary to large-vessel atherosclerotic disease associated with persistent trigeminal artery: a case report
Author(s) -
Fernando Benevides Falcão,
Guilherme Diogo Silva,
Cesar Castello Branco Lopes,
Aston Marques Midon,
Carlos André Oshiro
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.675
Subject(s) - trigeminal artery , medicine , context (archaeology) , posterior cerebral artery , stroke (engine) , circle of willis , basilar artery , cardiology , hemiparesis , anterior cerebral artery , cerebral arteries , internal carotid artery , superior cerebellar artery , middle cerebral artery , angiography , ischemia , mechanical engineering , paleontology , engineering , biology
Context: Cardioembolic events are the main cause of simultaneous anterior and posterior circulation stroke. Anatomical variants of the circle of Willis represent another rare mecanism. Persistent trigeminal artery is a carotid–vertebrobasilar anastomosis related to an increased risk of aneurysms, vascular malformations and stroke. Case report: A 67-year-old diabetic man was brought to the emergency department with a history of sudden onset of left hemiparesis. Neurologic finginds showed a hemiparesis, hemianesthesia and heminegligence (all left sided), right hemiataxia and a dysarthria. Brain Magnetic Resonance study revealed a isquemic stroke in right middle cerebral artery, right posterior cerebral artery (PCA) and bilateral superior cerebellar arteries (SUCA). Computed tomography angiography showed a right internal carotid artery oclusion and a persistent trigeminal artery. Causitive Classification System (CCS) revealed a large-vessel atherosclerotic stroke. A non-habitual simultaneous affection of PCA and SUCA resulted from a carotid artery embolization associated with anterior and posterior territories anostomosis by the persistent trigeminal artery. Secondary prevention consisted of aspirin 100mg/day and cardiovascular risk factor control. The patient remained free from others cardiovascular events, in rehabilitation, at the moment, in category 3 from the Ranking Modified Scale. Conclusions: The presence of a persistent trigeminal artery, in the context of a internal carotid oclusion, can chance our stroke-mecanism interpretation. Simultaneous anterior and posterior circulation stroke are compatible with large-vessel aterosclerotic disease.