Circle of Willis variation in a complex stroke presentation: a case report

BMC Neurology, 2006 · DOI: 10.1186/1471-2377-6-13 · Published: March 15, 2006

Simple Explanation

A 63-year-old woman experienced sequential left hemiparesis and right leg weakness after a car accident. Initially, spinal cord injury was suspected, but the final diagnosis was bilateral artery-to-artery embolic cerebral infarction. The patient had a dominant right internal carotid artery and an absent left A1 anterior cerebral artery segment, along with an anterior communicating artery aneurysm, contributing to the complex stroke presentation. The case highlights the challenges in diagnosing stroke, particularly when atypical symptoms mimic other conditions, and emphasizes the importance of considering anatomical variations in the circle of Willis.

Study Duration

Not specified

Participants

A 63-year-old right-handed woman

Evidence Level

Level 4: Case Report

Key Findings

1
The patient's symptoms of progressive triplegia initially suggested cervical spinal cord injury, but detailed evaluation revealed a cerebrovascular etiology.
2
Anatomical variation in the circle of Willis, specifically a dominant right A1 anterior cerebral artery segment and an absent left A1 segment, contributed to the bilateral cerebral infarction.
3
The likely mechanism for the left ACA territory infarction was artery-to-artery thromboembolism from the severe right internal carotid artery stenosis.

Research Summary

This case report describes a 63-year-old woman who presented with progressive triplegia following a road traffic accident, initially raising suspicion for cervical spinal cord injury. However, further investigation revealed bilateral artery-to-artery embolic cerebral infarctions due to anatomical variation in the circle of Willis, specifically a dominant right internal carotid artery and absent left A1 anterior cerebral artery. The case underscores the importance of detailed neurological evaluation and consideration of circle of Willis variations in patients presenting with complex stroke symptoms that may mimic other conditions.

Practical Implications

Diagnostic Vigilance

Clinicians should maintain a high index of suspicion for stroke, even when initial symptoms suggest other conditions like spinal cord injury.

Anatomical Awareness

Knowledge of circle of Willis anatomical variations is crucial in understanding complex stroke presentations and guiding appropriate management strategies.

Comprehensive Evaluation

Early, detailed neurological evaluation, including imaging of the brain and cerebrovascular system, is essential for accurate diagnosis and timely intervention in suspected stroke cases.

Study Limitations

1
Single case report limits generalizability.
2
Diffusion weighted images were not obtained initially.
3
The exact contribution of the rectal adenocarcinoma to the overall clinical picture remains uncertain.

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