Abstract Details

Title Azygos Anterior Cerebral Artery Occlusion Presenting with Acute Paraparesis: A Myelopathy Mimic

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 14-002

Objective

To highlight the key characteristics of a rare form of acute ischemic stroke (AIS) that mimics myelopathy.

Background The azygos anterior cerebral artery (ACA) is a vascular anomaly characterized by a singular A2 segment, found in less than 2.2% of the general population. ACA strokes account for less than 1.3% of all ischemic strokes and infarcts in patients with an azygos ACA are rare making diagnosis and management extremely challenging.

Design/Methods N/A

Results A 34-year-old male with morbid obesity, hypertension, alcohol and marijuana use disorders who presented with hyperacute onset bilateral lower extremity weakness (right more than left) along with difficulty standing and walking. Exam revealed mild bilateral lower extremity paresis, hyperreflexia with upgoing toes and difficulty ambulating. Computed tomography (CT) scan of the head demonstrated a hyperdense sign within the interhemispheric fissure over the rostrum of the corpus callosum and CT Angiography (CTA) confirmed proximal occlusion of an azygos ACA. CT Perfusion (CTP) demonstrated large penumbra in bilateral ACA territories and small infarct core. Per our institutional protocol, the patient received late-presenter thrombolysis 5 hours after Last Known Well (LKW). On discussion, thrombectomy was deferred since risks were deemed to outweigh benefits. Subsequent brain magnetic resonance imaging (MRI) showed minimal infarct burden in both ACA territories without intracranial hemorrhage. Upon discharge, the patient exhibited minimal difficulty walking but this was resolved by follow-up visit two months later. Despite exhaustive workup, stroke etiology remains cryptogenic.

Conclusions Hyperacute atraumatic paraparesis should raise suspicion for azygos ACA AIS, prompting emergent neuro-imaging of not only the spinal cord but also the brain parenchyma and its vasculature.

Authors/Disclosures
Rafail A. Chionatos, MD (Tufts Medical Center) PRESENTER	Dr. Chionatos has nothing to disclose.
Camelia Valhuerdi Porto, MD (Tufts Medical Center)	Dr. Valhuerdi Porto has nothing to disclose.
Nikita Srinivasan, MBBS	Dr. Srinivasan has nothing to disclose.
Naman Bareja, MBBS (Naman Bareja)	Dr. Bareja has nothing to disclose.
Maryam Bahadori, MD	Dr. Bahadori has nothing to disclose.
Lisa Scott, MD, DO (Tufts Medical Center)	Dr. Scott has nothing to disclose.
Aleksandra Yakhkind, MD (Tufts Medical Center)	Dr. Yakhkind has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LangAware. Dr. Yakhkind has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Yakhkind has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Round Table Group. Dr. Yakhkind has received research support from Sara's Wish Foundation Global Health Grant. Dr. Yakhkind has received publishing royalties from a publication relating to health care. Dr. Yakhkind has a non-compensated relationship as a Faculty with Massachusetts General Hospital CME that is relevant to AAN interests or activities.

��ɫ��

��ɫ��