Abstract W P30: Middle Cerebral Artery (MCA) Mid-to-distal M1 Segment Occlusion Masquerading as Isolated Central Facial Palsy (I-CFP)
Background & Purpose: Acute MCA occlusions produce well-known syndromes. Historically, I-CFP was largely attributed to lacunar syndromes affecting the corona radiata region or pons. With an advent of multimodal early vascular imaging, we sought to revisit lesion localization with I-CFP.
Subjects & Methods: Consecutive patients with symptoms of acute cerebral ischemia admitted to the inpatient service from January 2008 to December 2012 had NIHSS scores obtained by a certified neurologist unaware of the purposes of this study. All patients with I-CFP with or without dysarthria and without weakness (total NIHSS scores less than 3) underwent routine multimodal neurovascular imaging consisting of at least two of the following: CT-angiography, MRA, or standardized TCD. All ischemic lesions were localized by MRI within 72 hours from symptom onset.
Results: Of the 2202 consecutive patients, 879 (35%) had an NIHSS <3 (mean age 63±15 years, 46% women): 9 stroke patients (0.4%) presented with an I-CFP ± dysarthria. Of these, only 1 had a lesion in corona radiata and patent MCA, and 1 had pontine lesion without a proximal vessel occlusion (2/9, or 22%). The remaining 7 patients (78%) had mid-to-distal M1 MCA occlusions (artery-to-artery or cardioembolic stroke mechanism) with 6/7 (86%) having a prominent early anterior temporal artery on imaging or flow diversion on TCD. Corresponding ischemic lesions affecting cortical areas in the frontal lobe are shown in Figure.
Conclusions: Contrary to the current teaching of lesion localization for I-CFP, the majority of our acute patients had mid-to-distal MCA obstruction and cortical rather than lacunar lesions. This underscores the role of early vascular imaging in patients presenting with mild symptoms that could radically change management. Favorable anatomy and collateralization of flow can explain sparing of the rest of the MCA territory.
Author Disclosures: R. Bavarsad Shahripour: None. K.A. Sands: None. M.J. Lyerly: None. G. kumar: None. A. Sisson: None. A.W. Alexandrov: None. J.K. Cure: None. A.V. Alexandrov: None.
- © 2014 by American Heart Association, Inc.