title: Confined anterior cerebral artery infarction manifesting as isolated unilateral axial weakness.
abstract: We describe isolated unilateral axial weakness in three patients eventually diagnosed with anterior cerebral artery infarction (ACAI), a new clinical observation. Files of three ACAI patients (2 females, 1 male, ages 55-80) were retrospectively reviewed. All three presented to the ED with sudden unsteadiness. On initial neurological examination, all three patients manifested unilateral truncal deviation to the side contralateral to the weakness, even while seated. There was significant unilateral hypotonia due to substantial paravertebral weakness. None had pyramidal signs or increased limb tone. Speech, language, and cognitive performance were intact during admission examination. In all three patients, initial diffusion-weighted imaging (DWI) MRI showed small confined regions of restriction involving the posterolateral border of ACA territory; CT angiography was normal in one patient with a newly diagnosed atrial fibrillation but showed atherosclerotic vasculature with severe narrowing of the A3 segment of the ACA in two. Awareness of ACAI presenting as unilateral axial weakness is warranted. We suggest that optimal diagnostic management should include examination of axial tone. Ischemic involvement of distal ACA branches may herald a more extensive ACAI. Prompt diagnosis may enable thrombolysis or endovascular treatment, and blood pressure maintenance may allow adequate perfusion to damaged tissue.
authors.affiliation: Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: asaf.honig2@gmail.com.
authors.forename: Asaf
authors.initials: A
authors.lastname: Honig
authors.affiliation: Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: Ruthe@hadassah.org.il.
authors.forename: Ruth
authors.initials: R
authors.lastname: Eliahou
authors.affiliation: Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: eitanman1@gmail.com.
authors.forename: Eitan
authors.initials: E
authors.lastname: Auriel
mesh_terms: D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D009460:Neurologic Examination; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Anterior cerebral artery infarction; Axial weakness; Neurological examination