Bilateral caudate nucleus infarction associated with variant in circle of Willis

摘要

A 76-year-old woman presented with syncope. The next day she had disorientation, confabulations, slight dyspraxia of the left hand and bilateral Babinski signs. A fluid attenuated inversion recovery MR scan showed high signal intensity of the head of the caudate nuclei, the anterior part of the corpus callosum and the fomices, consistent with bilateral infaraion (fig 1). The vascular territory comprised bilaterally the recurrent artery of Heubner and the medial lenticulostriate artery, both branches of the anterior cerebral artery. The fornices and part of the genu of the corpus callosum are vascularised by proximal perforating branches of the anterior cerebral artery or the anterior communicating artery. Magnetic resonance angiography of the circle of Willis performed within 1 week showed absence of the Al segment of the anterior cerebral artery on the left side (fig 2). Echo Doppler of the carotid arteries showed moderate stenosis. Her Mini-Mental State Examination score 3 weeks later was 23/30. Verbal working memory and delayed recall were low, with normal recognition and no aphasia, apraxia or fluency problems.