Dados do Trabalho

Título

Stroke in posterior circulation due to anterior circulation stenosis: a case report of vertebral artery origin in internal carotid

RESUMO

Case-report: A 57 year old female admitted in the emergency department presenting sudden onset of left side weakness, drowsiness and vomiting. At neurological evaluation, hemiplegia and hemianopia were observed. Angiographic study showed right common carotid artery stenosis,internal carotid origin of right vertebral artery and right posterior cerebral artery occlusion. Because of the delayed time between symptoms onset and hospital admission, patient was not submitted to reperfusion therapy with alteplase or endovascular treatment. In 24 hours, massive edema caused by posterior ischemia was shown in a new CT scan. Then, the neurosurgical team performed a craniectomy. Patient was discharged 1 month after hospitalization, with several disabilities. Etiologic investigation was negative for cardiologic sources.

Discussion: The anatomical variations of cranial and extra cranial arteries are well established in literature, and its current implication as risk factor for ischemic stroke. In this case report, the patient had a stenosis in anterior circulation origin that had implications in posterior circulation, not having a fetal pattern of posterior cerebral artery, causing a stroke. The right vertebral artery had it`s origin at distal portion of extracranial internal carotid artery.
Final Comments: It is very important for the clinical practice of physicians to understand the variability of the human anatomy, as they help with the accurate diagnosis process. Rare variations can have implications in the setting of cerebrovascular diseases.

Palavras Chave

Stroke, Anatomical Vessel Variation