A 65-year-old woman presented with acute tetraparesis. Neurologic examination showed severe leg paresis and mild proximal arm weakness, bilateral extensor plantar responses, hyperreflexia, and abulia. Brain MRI showed bilateral anterior cerebral artery (ACA) territory infarctions (figure). On evaluation, she had patent foramen ovale, deep venous thrombosis, and bilateral moderate carotid artery disease. Bilateral ACA infarctions occur with simultaneous cardiac emboli to both ACAs or by a single azygous ACA supplying both hemispheres, and can result in acute paraparesis or tetraparesis and neuropsychological alterations due to frontal lobe damage.1,2 Although paraparesis and tetraparesis may initially suggest spinal cord involvement, bilateral frontal processes should be considered.
Figure Diffusion-weighted coronal MRI showing bilateral hyperintense parasagittal lesions
ACKNOWLEDGMENT
The authors thank Professor Didier Leys for critically reading the manuscript and for suggestions.
Footnotes
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*These authors contributed equally.
Disclosure: Dr. Di Filippo received a travel grant from Biogen to attend an international conference. Drs. Balucani, Parnetti, Cardaioli, and Floridi report no disclosures. Dr. Calabresi serves as an editorial board member of Lancet Neurology, the Journal of Neuroscience, and Synapse, and receives research support from Bayer Schering, Biogen, Boehringer Ingelheim, Eisai, Novartis, Lundbeck, Sanofi-Aventis, Sigma-Tau, UCB Pharma, Ricerca Corrente IRCCS and Ricerca Finalizzata IRCCS [European Community Grants SYNSCAFF and REPLACES], and the Italian Minister of Health.
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