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J Neurol Neurosurg Psychiatry 81:203 doi:10.1136/jnnp.2009.184622
  • Neurological picture

Atherosclerosis in congenital azygous solitary A2 anterior cerebral artery with simultaneous bifrontal infarctions

  1. Pei Kee Loh,
  2. Vijay K Sharma
  1. Division of Neurology, National University Hospital, Singapore, Singapore
  1. Correspondence to Dr P K Loh, Division of Neurology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; pei_kee_loh{at}nuh.com.sg
  • Accepted 5 June 2009

A 67-year-old woman with hypertension presented with non-specific dizziness for 2 days. She was fully conscious with blood pressure of 208/110 mm Hg. Neurological examination was unremarkable. She was started on antihypertensive medications.

About 12 h later, she became drowsy and confused. Her blood pressure was 160/80 mm Hg. She was noted to be lethargic and had profound weakness in both lower limbs (power Medical Research Council grade 0). She was catheterised due to urinary incontinence. She was very slow in verbal as well as motor responses and progressed to akinetic mutism by the next day.

MRI of the brain revealed acute ischaemic infarctions in both frontal lobes (figure 1A,B) in the territories of the anterior cerebral arteries (ACA). Time-of-flight MR …

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