Borggreve F, De Deyn P P, Mariën P, Cras P, Dierckx R A
Department of Neurology, General Hospital Middelheim, Antwerp, Belgium.
Stroke. 1994 Jun;25(6):1279-81. doi: 10.1161/01.str.25.6.1279.
Bilateral infarction in the anterior cerebral artery vascular territory is rare and usually results from rupture of an aneurysm of the anterior communicating artery. In the case of an anomaly of the anterior part of the circle of Willis, thrombosis also may lead to bilateral infarction.
A 73-year-old right-handed man presented with a complete loss of communicative behavior and an almost complete quadriplegia. 99mTc-hexamethylpropyleneamine oxime single-photon emission-computed tomography (HMPAO SPECT) of the brain showed a "horseshoe" image, reflecting bilateral perfusion defects in areas supplied by the anterior cerebral arteries. Postmortem examination of the brain revealed an unusual anomaly of the circle of Willis in which the postcommunicating part of the right anterior cerebral artery was absent.
In our patient a unique developmental anomaly of the circle of Willis indirectly contributed to bilateral infarction in the territory of the anterior cerebral artery. The patient's neuropsychological profile, dominated by akinetic mutism, was highly suggestive of involvement of the receptive language modalities. For the first time, 99mTc-HMPAO SPECT of the brain revealed a horseshoe image in bilateral infarction in the territory of the anterior cerebral artery.
大脑前动脉血管区域的双侧梗死罕见，通常由前交通动脉瘤破裂所致。在 Willis 环前部出现异常的情况下，血栓形成也可能导致双侧梗死。
一名 73 岁右利手男性出现完全丧失交流行为及几乎完全的四肢瘫。脑部 99mTc - 六甲基丙烯胺肟单光子发射计算机断层扫描（HMPAO SPECT）显示出“马蹄形”图像，反映大脑前动脉供血区域的双侧灌注缺损。脑部尸检发现 Willis 环存在异常，右侧大脑前动脉的交通后段缺失。
在我们的患者中，Willis 环独特的发育异常间接导致了大脑前动脉区域的双侧梗死。以运动不能性缄默为主导的患者神经心理学特征强烈提示接受性语言模式受累。首次通过脑部 99mTc - HMPAO SPECT 在大脑前动脉区域双侧梗死中发现马蹄形图像。
