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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(08): s00451809406
DOI: 10.1055/s-0045-1809406
Neuroimaging

Chessboard stroke attributed to intracranial atherosclerosis

Raul Medina-Rioja 
1   Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Departamento de Urgencias Neurológicas, Ciudad de México, Mexico.
,
Juan Carlos Lopez-Hernandez 
1   Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Departamento de Urgencias Neurológicas, Ciudad de México, Mexico.
,
Enrique Piña-Rosales 
2   Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Departamento de Neurología, Ciudad de México, Mexico.
,
Brenda Dzul-García 
3   Universidad Nacional Autónoma de México, Facultad de Medicina, Departamento de Integración de Ciencias Médicas, Ciudad de México, Mexico.
,
Andres Mercado-Pompa 
4   Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suarez”, Clínica de Enfermedad Vascular Cerebral, Ciudad de México, Mexico.
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A 73-year-old patient presented with sudden double vision and left-sided hemiparesis. A physical exam revealed palsy of the right VI cranial nerve and left arm/leg paresis. A magnetic resonance imaging (MRI) scan showed an acute stroke in the right pons ([Figure 1A]), with the initial workup suggesting intracranial atherosclerosis ([Figure 1B–D]).[1] Other causes were ruled out. The patient was treated with aspirin and clopidogrel and then discharged. He returned the day after with dysarthria and gait instability. A follow-up MRI scan revealed a left cerebellar stroke, creating a chessboard pattern ([Figure 2]).

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Figure 1 (A) Axial brain magnetic resonance imaging (MRI) scan in diffusion-weighted imaging (DWI) sequence showing an acute stroke located at the right pons. (B) Coronal angiotomography showing intracranial atherosclerosis in the internal carotid artery, causing 50% of narrowing of the lumen (4 mm versus 2 mm). (C) Tridimensional reconstruction of neck angiotomography showing left vertebral stenosis at the foraminal segment. (D) Coronal angiotomography highlighting extra- and intracranial atherosclerosis with a thrombus present in the left subclavian artery.
Zoom
Figure 2 (A) Axial brain MRI in DWI sequence showing two strokes located at the right pons and (B) the left cerebellum mimicking a chessboard.

 

Conflict of Interest

The authors have no conflict of interest to declare.

Authors' Contributions

Conceptualization: RMR, BDG; Funding acquisition: RMR; Supervision: RMR; Writing - original draft: RMR, EPR; Writing – review & editing: AMP, CLH.


Data Availability Statement

The data that support the findings of the present study are available upon reasonable request from the corresponding author.


Editor-in-Chief: Ayrton Roberto Massaro 0000-0002-0487-5299.


Associate Editor: Antonio José da Rocha 0000-0003-2591-9171.



Address for correspondence

Raul Medina-Rioja

Publication History

Received: 09 February 2025

Accepted: 13 April 2025

Article published online:
21 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Raul Medina-Rioja, Juan Carlos Lopez-Hernandez, Enrique Piña-Rosales, Brenda Dzul-García, Andres Mercado-Pompa. Chessboard stroke attributed to intracranial atherosclerosis. Arq Neuropsiquiatr 2025; 83: s00451809406.
DOI: 10.1055/s-0045-1809406

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Zoom
Figure 1 (A) Axial brain magnetic resonance imaging (MRI) scan in diffusion-weighted imaging (DWI) sequence showing an acute stroke located at the right pons. (B) Coronal angiotomography showing intracranial atherosclerosis in the internal carotid artery, causing 50% of narrowing of the lumen (4 mm versus 2 mm). (C) Tridimensional reconstruction of neck angiotomography showing left vertebral stenosis at the foraminal segment. (D) Coronal angiotomography highlighting extra- and intracranial atherosclerosis with a thrombus present in the left subclavian artery.
Zoom
Figure 2 (A) Axial brain MRI in DWI sequence showing two strokes located at the right pons and (B) the left cerebellum mimicking a chessboard.