Disclosures: Adeeb Syed, DO: No financial relationships or conflicts of interest

Case Description: The patient presented to the emergency room with dizziness, bilateral lower limb weakness, paresthesias in his hands, and difficulty ambulating. Physical examination displayed bilateral lower limb, left greater than right weakness and ataxic gait. The National Institute of Health stroke scale score was five. Computerized tomography scan of the head did not show acute pathology. Magnetic resonance imaging of his brain showed bilateral acute, right greater than left, anterior cerebral artery infarcts. Angiography revealed a hypoplastic right A1 segment. Investigation for etiology of the stroke was inconclusive. The patient was discharged to acute inpatient rehab where he participated in an intensive multidisciplinary therapy program. On admission, he required contact guard assistance for mobility and maximal assistance for lower body dressing. On discharge, he was independent for mobility and modified independent for most activities of daily living.

Setting: Level 1 Trauma Center with Acute Inpatient Rehabilitation Facility (IRF)

Patient: A 60-year old male with history of coronary artery disease status post multiple stents, hypertension, hyperlipidemia who sustained acute, bilateral anterior cerebral artery strokes. Assessment/

Results: This patient with multiple comorbidities presented with signs and symptoms of bilateral anterior cerebral artery strokes

Discussion: Anterior cerebral artery strokes compose an estimated 0.3 to 4.4 percent of all strokes. Bilateral anterior cerebral artery strokes are likely rare as an anterior cerebral artery is uncommonly supplied by the contralateral anterior cerebral artery. This occurs an estimated 10 percent of the time where there is hypoplasia of the A1 segment of anterior cerebral artery. This patient presented with several symptoms leading to diagnosis of bilateral anterior cerebral artery strokes. There are few case reports of bilateral anterior cerebral artery strokes and in particular patients who participated in acute inpatient rehab.

Conclusion: Bilateral anterior cerebral artery strokes are rare, but should be considered in patients with bilateral lower extremity weakness & difficulty ambulating

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/double-trouble-a-case-of-bilateral-anterior-cerebral-artery-strokes/