Two patients with bilateral anterior cerebral artery (ACA) territory infarction are presented whose initial diagnosis was basilar artery occlusion. Both had tetraparesis; in one it was asymmetrical. Both had their eyes open and did not respond to command except that after a delay they followed with their eyes a smoothly moving object; this was the only sign of awareness. One patient had a clear vertical gaze palsy in the upward and downward direction unaccompanied by pupillary abnormalities. Computed tomography revealed fresh bilateral ACA infarction in both patients; occlusion in the hind brain circulation was excluded by angiography in one. Both patients suffered from atrial fibrillation, so cardiac embolism was the most likely cause of the stroke. We conclude that bilateral ACA territory infarction should be considered in the differential diagnosis of basilar artery occlusion, even if accompanied by vertical gaze palsy.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Baptista A (1963) Studies on the arteries of the brain. The anterior cerebral artery: some anatomic features and their clinical implications. Neurology 13:825–835
Barris RW, Schuman HR (1953) Bilateral anterior cingulate gyrus lesions. Syndrome of the anterior cingulate gyri. Neurology 3:44–52
Bauer G, Gerstenbrand S, Rumpl E (1979) Varieties of the locked-in syndrome. J Neurol 221:77–91
Bogousslavsky J, Regli F (1990) Anterior cerebral artery territory infarction in the Lausanne Stroke Registry. Arch Neurol 47:144–150
Critchley MD (1930) The anterior cerebral artery, and its syndromes. Brain 53:120–165
Ferbert A, Brückmann H, Drummen R (1990) Clinical features of proven basilar artery occlusion. Stroke 21:1135–1142
Ferbert A, Müllges W, Biniek R (1990) Fascicular third nerve palsy with decreased vertical saccade velocity of the contralateral eye. Neuro-ophthalmology 10:33–38
Fisher M, McQuillen JB (1981) Bilateral cortical borderzone infarction. A pseudobrainstem stroke. Arch Neurol 38:62–63
Freemon FR (1971) Akinetic mutism and bilateral anterior cerebral artery occlusion. J Neurol Neurosurg Psychiatry 34:693–698
Heide W, Fahle M, Koenig E, Dichgans J, Schroth G (1990) Impairment of vertical motion detection and downgaze palsy due to rostral midbrain infarction. J Neurol 237:432–440
Plum F, Posner JB (1980) Diagnosis of stupor and coma. Davis, Philadelphia
Webster JE, Gurdjian ES, Lindner DW, Hardy WG (1960) Proximal occlusion of the anterior cerebral artery. Arch Neurol 2:19–26
About this article
Cite this article
Ferbert, A., Thron, A. Bilateral anterior cerebral artery territory infarction in the differential diagnosis of basilar artery occlusion. J Neurol 239, 162–164 (1992). https://doi.org/10.1007/BF00833918
- Bilateral anterior cerebral artery infarction
- Akinetic mutism
- Vertical gaze palsy