A 69 year old woman developed the abrupt onset of a global aphasia, right hemiplegia, left gaze preference and right visual field loss.
CT axial images - 2 days later. Note the large infarction in the distribution of the left middle cerebral and posterior cerebral arteries. A lesion such as this can occur from multiple emboli; however, it is more likely that a single occlusion caused this lesion. A number of individuals have a normal anatomic variant known as a persistent fetal circulation, where the PCA arises directly from the Posterior Communicating artery off of the carotid. In this case, an embolus at the top of the carotid can then infarct the middle cerebral and posterior cerebral territories. In this case, the Anterior Cerebral territory is spared; presumable by way of an intact anterior communicating artery where blood can flow from the other side. In this case, subsequent angiography confirmed a complete left internal carotid artery occlusion with a persistent fetal circulation on the left.
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