Anterior Choroidal Artery Infarct: A Triathlon of Neurodeficits, Not Triad.

An 80-year-old male with a known case of Type-II diabetes mellitus and hypertension presented to a primary health care center with acute-onset right-sided weakness of the body on waking up. An urgent cranial CT done at the nearest scan center was normal; however, his left eye vision deteriorated by the end of the scan. He was treated conservatively without thrombolysis. At a presentation to our hospital after 3 days, right hemiparesis, left hemianopia, and right hemianesthesia were elicited on examination. Non-contrast CT and MRI [Figure 1], followed by CT-angiography [Figure 2] revealed a classical subacute infarct in the left anterior choroidal artery (AChoA) territory..Figure 1: Axial sections at the ganglionic level of non-contrast CT (a), Flair (b), T2 (c), diffusion-weighted imaging (d), Apparent diffusion coefficient (e), and T1 (f) sequences of MRI showing the left anterior choroidal artery territory infarct with involvement of the posterior limb of the internal capsule, lateral thalamus, and globus pallidus internusFigure 2: Sagittal maximum intensity projection images of CT-angiography of the right (a) and left (b) internal carotid arteries show the origin (arrow) and proximal course of the right anterior choroidal artery territory and the non-opacification (circle) of the left anterior choroidal artery territoryAnterior choroidal artery syndrome is a rare form of stroke characterized by a clinical triad of hemiplegia, hemianesthesia, and contralateral hemianopia.[1] However, in about 50% of the cases, the triad may not be complete depending upon the status of distal collaterals and the level of AChoA occlusion. Its origin is from the posterior wall of the carotid artery as the distalmost branch. The proximal cisternal segment predominantly supplies the posterior limb of the internal capsule, the optic tract, and the lateral geniculate nucleus. Distally, the intraventricular segment feeds the choroid plexus.[2] AChoA shares numerous anastomoses with the branches of the posterior choroidal and posterior cerebral arteries, except the end-arteries of the posterior limb of the internal capsule. Hence, the complete AChoA territory infarct seen in our patient involving the posterior limb of the internal capsule, lateral thalamus, lateral cerebral peduncle, optic tract, globus pallidus internus, and tail of the caudate nucleus is rare. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.