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Abstract Details

Left Anterior Cerebral Artery Territory Stroke in the Setting of Duplicate Left Middle Cerebral Artery and Diffuse Intracranial Atherosclerosis
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
242

Highlight a case of Left ACA territory stroke initially thought to be presenting as a Left MCA syndrome in the setting of a duplicate vs accessory Left MCA.
Duplicate and accessory MCAs are reported to occur with a frequency of 0.2%-2.9% and 0.3% -4.0% respectively. Duplicated MCAs typically supply the cortical territory of the temporopolar and anterior temporal areas and may include the middle temporal arteries whereas accessory MCAs supply the cortical territory of the orbitofrontal and prefrontal arteries.
Clinical case 
An 86 year-old right handed female presented after a fall with global aphasia and right hemiparesis that spared her face. Her medical history is notable for hypertension, hyperlipidemia, dementia and breast neoplasm. CT head was negative. CTA demonstrated diffuse intracranial atherosclerosis, with accessory vs duplicate left MCA and with native left MCA occluded at the origin, as well mid A2 occlusion of left ACA. Patient was treated with tPA but was excluded from thrombectomy due to anatomical variance and pre-existing dementia. 24h post tPA, patients aphasia improved significantly, however still with significant right hemiparesis. MRI Brain showed acute left ACA stroke. Stroke mechanism presumed to be due to symptomatic intracranial atherosclerosis, and patient was treated with Aspirin and Plavix per SAMMPRIS protocol.  At 1 month follow-up, patient had significant improvement in right hemiparesis. 
The occluded left M1 segment in this case appears chronic with the suspected duplicate MCA sufficiently supplying the majority of the left MCA territory. Rapid resolution of the aphasia may be due to sufficient collateral flow from this duplicate MCA tree or PCA to the ACA territories. Additionally, the occluded left M1 may be a red herring in the setting of an occluded left A2 and supports the idea of a duplicate versus accessory arteries proving dominant in arterial supply to the left hemisphere.
Authors/Disclosures
Haroon K. Khawar, DO (South Shore University Hospital)
PRESENTER 		Dr. Khawar has nothing to disclose.
Jordana S. Schneider, DO (Northwell) Dr. Schneider has nothing to disclose.