Article ID: 10815
A 62-year-old woman was admitted to our hospital due to a sudden onset of right hemiparesis with lower limb dominance and consciousness disturbance without headache. Magnetic resonance imaging (MRI) of the brain showed ischemic lesions in the territories of the bilateral anterior cerebral arteries. Anterior cerebral artery dissection was suspected because MRI angiography (MRA) revealed a dilation and stenosis in the anterior cerebral artery. Digital subtraction angiography (DSA) and CT angiography (CTA) demonstrated the fusion of both A2 segments of the anterior cerebral artery to form a single artery and a pearl and string sign in the A2 segment. From these findings, she was diagnosed with azygos anterior cerebral artery dissection. Subarachnoid hemorrhage and hemorrhagic infarct were seen during treatment for cerebral infarction. This case indicates that it is important to recognize azygos anterior cerebral artery dissection as a cause of cerebral infarction at bilateral anterior cerebral artery territories, although it is so rare.
