Abstract Details

Title A Case Series: Acute ACA Stroke Presenting With Spasticity

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-001

Objective Demonstrate cases of acute anterior cerebral artery (ACA) stroke presenting with spasticity

Background Given the importance of time in stroke treatment, prompt recognition of unusual syndromes is essential. Spasticity, a well-known post-stroke phenomenon, is not a common presentation of acute ACA stroke. We illustrate three patients presenting with acute spasticity, all diagnosed with ACA stroke.

Design/Methods Three cases of acute ACA stroke were identified at the authors’ institution and associated hospitals. Data analysis included age, sex, symptoms, risk factors, treatment, and imaging findings.

Results

Case 1: 48 year old healthy female presented with right leg weakness. Exam demonstrated increased tone with spasticity, hyperextension, plegia and loss of sensation in the right leg. NIHSS 5. Patient was treated with tPA. MRI demonstrated acute left paracentral lobule stroke. Etiology cryptogenic.

Case 2: 67 year old male with prior atheroembolic strokes presented after a fall. Exam demonstrated left arm flexion contracture and left leg flaccid plegia. NIHSS 11. Neurological change was not recognized in time for tPA. MRI demonstrated right ACA stroke involving the frontal, parasagittal, and cingulate gyrus. Etiology atheroembolic vs cardioembolic from cardiac thrombus.

Case 3: 49 year old healthy female presented with right sided weakness. Exam demonstrated right arm contracture and right leg spastic extension. NIHSS 8. tPA was not given due to unfamiliar presentation. MRI demonstrated left parasagittal and anterior cingulate gyrus stroke. Etiology cryptogenic.

Conclusions Damage to the corticospinal tract commonly results in negative symptoms (weakness, hyporeflexia) but can also result in positive symptoms (spasticity, hyperreflexia, and rigidity) as in these cases. In patients with sudden onset of symptoms, focal weakness and increased tone, ACA and anterior cingulate gyrus stroke and tPA should be considered if there are no contraindications. Differential diagnosis may include medication or illicit drug induced dystonia, musculoskeletal injury or functional presentation.

Authors/Disclosures
Amy W. Laitinen, MD (Baptist Health Marcus Neuroscience Institute) PRESENTER	No disclosure on file
Chindhuri Selvadurai (University of Connecticut)	Dr. Selvadurai has nothing to disclose.
Hardik Amin, MD (Yale University School of Medicine)	No disclosure on file

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