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Images in Neurology |

Bilateral Infarction of the Corpus Callosum in a Patient With a Single Pericallosal Artery ONLINE FIRST

Antonio Cruz-Culebras, MD1; Rocío Vera, MD, PhD1; Juan Martinez San Millan, MD2
[+] Author Affiliations
1Stroke Unit, Hospital Universitario Ramon y Cajal, Madrid, Spain
2 Hospital Universitario Ramon y Cajal, Department of Radiology, Madrid, Spain
JAMA Neurol. Published online August 08, 2016. doi:10.1001/jamaneurol.2016.1230
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This case report describes the clinical and imaging features of a man in his 60s who had occlusion of a single pericallosal artery causing

bilateral corpus callosum infarction.

A man in his 60s with a long-term history of smoking and severe hypertension presented with acute speech disturbances and gait instability on awakening. A clinical examination revealed bilateral tremor, dysarthria, decreased verbal fluency, and ataxia with shuffling gait. Classic disconnection syndrome was not seen in this patient. Computed tomography angiography performed 12 hours after detection of symptoms revealed occlusion of a single pericallosal artery derived from a left anterior cerebral artery (Figure 1). Cerebral magnetic resonance imaging, performed 24 hours after admission, revealed infarction confined to the corpus callosum (Figure 2). The splenium of the corpus callosum was preserved, which explains why the patient did not have classic disconnection syndrome (the posterior pericallosal artery, a branch of the posterior cerebral artery, supplies this region of the corpus callosum).1,2 The arteries within the region showed many variations that led, in this patient, to an atypical presentation with nonlocalizing signs of acute stroke. Large artery atherosclerosis was the probable cause in this case. Two months after discharge, the patient was able to walk alone, and speech disturbances partially improved (modified Rankin score, 2).

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Figure 1.
Axial Magnetic Resonance Imaging (MRI) Scans Showing Diffusion Restriction Involving the Corpus Callosum (CC)

Cranial MRI scans show diffusion-weighted imaging sequences. Axial views of the body of the CC and the genu of the CC (A and B) and sagittal view, showing acute ischemic lesion affecting bilaterally the genu and body of the CC (supplied by a single pericallosal artery) (C). The splenium of the corpus CC is preserved (white arrowhead [B]), receiving blood supply from the posterior territory.

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Figure 2.
Computed Tomography (CT) Scans and 3-Dimensional (3-D) CT Angiograms Revealing Occlusion of a Single Pericallosal Artery Derived From a Left Anterior Cerebral Artery

Computed tomography angiogram of the Circle of Willis shows single pericallosal occlusion (white arrowhead [A]) derived from left A1 trunk (red arrowhead [B]). The right A1 segment is supplying frontopolar territory and callosomarginal branches (yellow arrowhead [C]). Incidental finding of an accessory right middle cerebral artery is seen appearing near the right anterior cerebral artery (blue arrowhead [B]).

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