Akinetic Mutism after Embolization of an Anterior Communicating Artery Aneurysm: Willis Variants

Background: Acute bilateral stroke of the anterior cerebral artery is rare. Akinetic mutism is the most common manifestation. This case report describes an acute bilateral stroke after an embolization of an anterior communicating artery aneurysm.

Case: We report the case of a women presenting with sudden onset headaches associated with meningeal syndrome. Medical treatment was initiated in intensive care unit. Cerebral angiography showed agenesis of the A1 segment of the right ACA and a bilobed aneurysm of anterior communicating artery. The occlusion of the aneurysm by coils was total with no per-procedural complications. On postembolization examination, we found a paraplegic patient with an akinetic mutism and altered behavior. Given the sudden onset of her symptoms, the possibility of vascular etiology was considered. MRI found an acute bilateral anterior circulation stroke. We started directly levodopa and rehabilitation therapy. Two months after her initial presentation, the patient has made a good recovery; she speak and walk again.

Discussion: The occurrence of these three entities together: anterior communicating artery aneurysm, acute bilateral anterior circulation stroke, coexisting akinetic mutism, is a rare combination. This case shows the benefit of intensive rehabilitation therapy and using levodopa to treat akinetic mutism.

Publication History

Article published online:
09 February 2023