Anterior choroidal artery infarction.

Accepted 13 December 2017 DesCripTion A 38-year-old male patient with a history of hypertension presented with left hemiplegia, hemianaesthesia and hemianopia. MRI of the brain showed anterior choroidal artery (AchA) territory infarct (figure 1). MRI brain angiography and 2D echo were normal. Serum fasting lipid profile, sugar levels, thyroid studies, serum homocysteine levels and antinuclear antibody (ANA), double-stranded deoxyribonucleic acid (DsDNA) and antiphospholipid antibody (APLA) were negative. Trans-oesophageal echocardiography and Holter monitoring were normal. Workup for sickle cell anaemia was negative. The territory of AchA is shown in figure 2. The possible clinical presentations of AchA infarcts are as follows: A. The classic triad (complete)—hemiplegia, hemisensory loss and homonymous hemianopia. B. Lacunar syndromes. C. Ataxic hemiparesis. The patients with AchA infarcts were divided into two groups according to the size of the infarct: large (diameter ≥20 mm) and small (diameter <20 mm). Large AchA strokes causing complete triad are rare and are strongly associated with carotid stenosis and cardioembolic sources. Small AchA strokes are responsible for more common lacunar strokes and are usually due to hypertension, diabetes mellitus (DM) and hyperlipidaemia. Complete triad of hemiplegia, hemianaesthesia and hemianopia with radiological correlation is rare in AchA infarction. This is because of its rich anastomoses with posterior cerebral artery (PCA), Figure 1 Axial diffusion weighted MRI shows restricted diffusion in (A,B) right lateral thalamus, posterior limb of internal capsule; hippocampal gyrus and uncus and (C) paraventricular corona radiata and uncus. (D) Coronal T2 image showing involvement of same areas.